University of California • Berkeley

I

THE LIBRARY

OF

THE UNIVERSITY
OF CALIFORNIA

\>

PRESENTED BY

'PROF. CHARLES A. KOFOID AND
MRS. PRUDENCE W. KOFOID

C8
1793

JgOM

FIRST LINES

OF THE

PRACTICE r- PHY SIC.

B Y

WILLIAM CUL ;N, M. D.

LATE PROFESSOR OF THE PRACTICE OF PHYSIC IN TH£
UNIVERSITY OF EDINBURGH, &C. &C.

IN TWO V O L U M E S.

WITH PRACTICAL AND EXPLANATORY NOTES,

B Y

JOHN ROTH ERA M, M. D.
TO WHICH IS PREFIXED

THE LIFE OF THE AUTHOR.

VOL. II.

N E W- Y ORE:

BT SAMUEL CAMPBELL, BOOK-SELLER AND
No. 37, HANOVER-SQJJARK.

CONTENTS

OF THE

SECOND VOLUME,

PARTI. B O O K IV.

CHAP. VI.

Page

Of the Menorrhagia, or the immoderate flow of
the Menfes

CHAP. VII.
Of the Leucorrhcea, Fluor Albtts, or Whites 19

CHAP. VIII.
Of the Amenorrhcea, or Interruption of the Menfes 21

C H A P. IX.

Of Symptomatic Hemorrhages 30

Sedl. I. Of the Hematemajis, or Vomiting of

Blood ' ibid

Seel. II. Of the Hematuria, or the 'voiding of

Blood from the Urinary Pafjage 39

BOOK' v.

Of Projluvia, or Fluxes, with Pyrexia 46

CHAP. I.
Of the Catarrh 47

CHAP. II.
Of the Dyfentery c6

PART II.
Of NeurofeSy or Nervous Difeafes 65

BOOK I.
Of Comate) or, of the lofs of Voluntary Motion 67

CHAP. I.
Of Apoplexy ibid

C H A P.

k CONTENTS.

CHAP. IL

Of Palfy Page S8

BOOK II.

Of Adynamia i or Difeafes corifaftinq in a weaknefs,

or lofs of Motion in either the 'vital or natural
Functions 101

CHAP. I.
Of Syncope-^ or Fainting ibid

C H A P. II.
Of Dyfpefi/ia, or Indigeftion no

CHAP. III.

Of Hypochondria/is^ or tie Hypochondriac Affec-
tion , commonly called Vapours or Low Spirits 126

BOOK III.

Of Spafmodic Affections without Fever 136

Sect. I. Of the Spafmodic Affections of the ani-
mal Functions 137

CHAR I.
'Of Tetanus 1^9

C H A P. IL
Of EpUepfy 153

CHAP. III.

Of the Chorea^ or Dance of St. Fit us 178

Sea. II. Of the Spafmodic Affections of the Vi-
tal Functions 182

CHAP. IV.
Oftbs Palpitation of the Heart ibul

C H A P. V.
Of Dyfpncea, or difficult Breathing 185

CHAP. VI.
Of AJlhma 187

CHAP. VII.

he Cbincougv, or Hooping Cough 198

Sect. III. Oftbt Spafmsdic Ajfcaions in the

:\-;s 209

C H A P.

C O N T E N T

C H A P. VIII.

Of the Pyrqfis, or what is named in Scotland

the Water-brajh Page 20

CHAP. IX.
Of the Colic 212

CHAR - X.
Of the Cholera -222

CHAP. XL
Of Diarrhoea^ or Loofenefs 227

CHAP. XII.
Of the Diabetes 243

CHAP. XIII.
Of the Hyfteria^ or the Hyfteric Difeafe 247

CHAP. XIV.
Of Canine Madnefs and Hydrophobia 254

BOOK IV.

Of Vefania^ or of the Dif orders of the Intelkftual
Functions 256

CHAP. I.
Of Vefaniae in general Ibid

CHAP. II.
Of Mania , or Madnefs 270

C H A P. III.
Of Melancholy, and other forms of Infant 'ty 281

PART III.
Of Cachexies 290

BOOK I.
Of Emaciations 291

BOOK II.
Of Intumefcentia^ or General Swellings 303

CHAP. I.
Of Adipofe Swellings 304

CHAP. II.
Of Flatulent Swellings 308

CHAP. Ill,
Of Watery Swellings, or Dropfies 3 1 8

yi CONTENTS,

Seft. I. Of Anafsrca Page 333

Se<5t. II. O/* the Hy.drotb.orax, or Dropfy of

the Breaft 344

Seft. III. Of the Afcltcs, or. Dropfy of th?

Lower Belly 350

CHAP. IV.
Of General Swellings, arifing from an increased

bulk of the whole fubftance of particular $ arts 355
Of Rachitis, or Rickets ibid

BOOK 1IL

Of the Impetignisi or depraved habit, with of-
feftions of the Skin 367

C H A P. I.
Of Scrophula, or the King's Evil 368

CHAP. II.
Of SipbyHs) or the Venereal Difeafe 378

CHAP. III.
Of Scurvy 394

C H A P. IV.
Of Jaundice 404,

FIRST

FIRST LINES

OF THE

PRACTICE OF PHYSIC.

PART I. BOOK IV.

CHAP. VI.

-*

OF THE MENORRHAGIA,

OR THE

IMMODERATE FLOW OF THE MENSES.

DGCCCLXVI.

BLOOD difcharged from the vagina may proceed
from different fources in the internal parts : but
I here mean, to treat of thofe difcharges only, in which
the blood may be prefumed to flow from the iame
fources that the menfes in their natural Hate proceed
from ; and which difcharges alone, are thofe proper-
ly comprehended under the prefent title. The title
.of Metrorrhagia, or haemorrhagla uteri^ might compre-
hend a great deal more.

DCCCCLXVII.

The menorrhagia may be confidered as of two kinds ;
VOL, II. B either

io PRACTICE

either as it happens to pregnant and lying-in
or as it jjappens to women neither pregnant nor hav-
ing recently born children. The Sift kind, as con-
nected with the circ\imi£ances of pregnancy and child-'
bearing, (which are not to .jf in the prefenc

courfe) I am not to contlder here, but ihall confine
znyfelf to theiecond kind of menorrhagia only.
DCC..CCLXVIH.

The flow of the me'nfes is coniidered as immoderate,
when it recurs more frequently*, when it continues
longer, or when, during the ordinary continuance §,
it is more abundant -[• than is ufiial with the fame per-
fon at other times,

DCCCCLXIX.

As the mod part of women are liable. to fonie ine-
quality with rcfpect to the period, the duration, and
the quantity of their menfes ; fo it is not every ine-
quality in thefe refpeclis that is to be ccaiidercd as a
difeafe ; but only thofe deviations^, which ar^lxcei-..
live in degree, which are permanent, and which in-
duce a manifefi ftate of debility.
DCCCCLXX.

The circumftances (DCCCCLXVUI. Dcccajpjix.)
are thofe which chiefly conititute the menorniagia •:
but it is proper to obferve, that although I allow the
frequency, duration, and quantity of the menfes to be
judged of by what is ufual with the *;>;v-e individual at
other times ; yet there is, in thefe particulars, fo much

in the w lex, that in

any

* The ufual period rs from T::ys.

§ The time o£ it'fl nt people;

it fcldom continues l'>n^v;' ih or fliprter than two. —

In general, \vo:'u:ti »>! a lax and >n have a

. '

copious and a i« •

-J- It is i :~-;;rtain precsKiy \vh i-yis

ufually discharged ; but the women themfe'ves can generally in-
:he phyiiciau with fufficicnt cx-.idtnefs for ri-^ulatiug thcpi.vj-
. ht'thcr the Jilcharge be fcnmodcratc*

OF i5 H Y S I C. is

-

individual in whom there occurs any confiderable
deviation from the common meafure, fuch a deviation
af conftantly recurring, may be ccnfidered as at leaft
approaching to a morbid ftate, and as requiring molt
of the precautions which I mail hereafter mention as!
neceiTary to be attended to by thofe who are actually iii
fuch a ft ate.

DCCCCLXXI.

However we may determine with refpect to the cir-
cumftances DCCCCLXVIII. DCCCCI.XIX. it mull Hill be
f:i lowed, that jfche iVa model are flow of the menfes is
efpecialiy to ^•fcrmhied by thofc fy in p Corns afiect-
ing other function's of the body, which accompany and
follow the di (charge.

When a larger flow than ufual of the menfes has i
been precgde^bv headach, giddinefs, or difpncea, and
has be^ft - in fci*yi cold ftage, and is attended

with.muo^Hm of theoack and loins, with a frequent
pulfe, i. I d thirft, it may then be confidercd as
preternaturally large.

DCCCCLXXIL

TVhen, in confequcnce of the circumftances DCCCC-
LXVIII. — DCCCCLXXI. and the repetition of thefe, the ;
f^ice becomes pale; the pulfe g- ;:;,k: an unufti- |

al tietitoty is felt in excrciib ; the breathing is hurried i
by n, • cxsrcife: \vhen5 aifo, the b ck becrmcs

pained From any continuance in an erect pofture ;
when the extremities become frequently cold; and !
when in the evening the feet appear to be affected with
cedemntous fweiling; we may from tbrfe fymp:
certainly conclude, that the flow of the mehfes has
;>ecn 1^1:10 derate, and has already induced a danger- i
culflate of debility •

DCCCCLXXIII.

The debility thus induced does often difcover irfelf
y affections cf the ftomach, as anorexia and other
B 2

12 PRACTICE

fymptoms of difpepfia ; by a palpitation of the heart,
and frequent faintings; by a weaknefs of mind liable
to ftrong emotions from flight caufes, efpecially when
fuddenly prefented.

DCCCCLXXIV.

That flow of the menfes, which is attended with
barrennefs in married women, may be generally con-
lidered as immoderate and morbid.
DCCCCLXXV.

Generally, alfo, that flow of the menfes may be con-
fidered as immoderate, which is preceded and follow-
ed by a leucorrhcea.

DCCCCLXXVr.

I treat of menorrhagia here as an active hemorrhagy,
becaufe I conilder menftruation, in its natural ftate, to
be always of that kind ; and although there fhould be
cafes of menorrhagia which might be confidered as
.purely paffive, it appears to me that they cannot be fo
properly treated of in any other place.

DCCCCLXXVII.

The menorrhagia (DCCCCLXXVIU, et feq.*) has for
its proximate caufe, either the hemorrhagic effort of
the uterine veffeis preternaturally increafed, or a pre-
ternatural laxity of the extremities of the uterine ar-
teries, the hemorrhagic effort remaining as in the na-
tural ftate.

DCCCCLXXVHI.

The remote caufes of the hemorrhagia may be, ift,
Thofe which increafe the plethoric ftafe of the uterine
veflels ; fuch as a full and nouriming diet, much ftrong
liquor, and frequent intoxication, idly, Thofe which
determine the blood more copioufly and forcibly into
the uterine veflels ; as violent {trainings of the whole
body ; violent (hocks of the whole body from falls ;
violent ftrokes or contufions on the lower belly ; vio-
lent exercifc, particularly in dancing ; and violent paf-
fions of the mind. 3^, Thqfe which particularly ir-

O F P H Y S I C. 13 i

ritatc the vefiels of the uterus ; as excefs in venery ;
the exercife of venery in the time of menflruation ; a
coitive habit, giving occaiion to violent {training at
ftool ; and cold applied to the feet1*. 4th ly, Thofe
which have forcibly overft rained the extremities of
the uterine veflels ; as frequent abortions ; frequent
child-bearing without nurfingf ; and difficult tedious
labours, Or, lajtly, Thofe which induce a general lax-
ity ; as living much in warm chambers, and drinking
much of warm enervating liquors, fuch as tea and
coffee.

DCCCCLXXIX.

The effects of the menorrhagia are pointed out in
DCCCCLXXH — DccccLxxm. where I have mentioned
the feveral fymptoms accompanying the difeafe ; and
from thefe the confequences to be apprehended will
alfo readily appear.

DCCCCLXXX,

The treatment and cure of the menorrhagia muft

be

* It is difficult to account for the catife of menorrhagia ; it may
perhaps be owing to the circulation through the lower extremities
being obftrufted or impeded, and confeqirently a greater How of
blood to the uterus. The fa6l, however, is certain ; for experience
fufficiently evinces that menorrhagia frequently follows 'in imprudent
cxptfure of the feet to cold, efpecially damp cold. Sitting in wet
fiioes, or in a damp cold room with a Hone floor, ought to be care-
fully avoided by ladies of a delicate conilitution.

f By nurfing, the fluids are determined to the bre.afl> and in a
peculiar manner derived from the uterus. This part of the cecono-
my of nature phyfiologifts have not yes: fufncieutly explained, but
the fa 61 is weli ascertained. Nurfing is not only ufcful in preventing
nienorrliagia, but as it derives the fluid ; -us, it prevents

alfo frequent child-bearing ; and conic; atcil

advantage of all others, time is allowed to the uterus for regaining it's
former tone and ftrength : The fubfequent child-births are aif •
dercu more eafy than they would ether wife be, and the ch'-
more healthy. It would be improper to enumerate: Ivan- ,

tagcs of nurfing in this^ace, as I fhall refervc tiic ex-
them for a future publication.

I i4 PRACTICE

be different, according to the different caufes of th$
difeafe.

In all cafes, the firft attention ought to be given to
avoiding the remote caufes, whenever that can be
done ; and by that means the difeafe may be often en-
tirely avoided.

When the remote caufes cannot be avoided, or when
the avoiding them has been neglected, and therefore
a copious rnenftruation has come on, it iliould be mo-
ted as much as pofiible, by abftaining from all e2c-
fe, 'either at the coming on, or during the conti,
nuance of the menftruation ; by avoiding even an
creel pofture vis much as poffible ; by fliunning exter-
nal heat, and therefore warm chambers and foft beds ;
by ufing a light and cool diet ; by taking cold drink,
at lead as far as former habits will allow : by avoiding
venery ; by obviating coftivenefs, or removing it by
laxatives that give little 'ftirrmlus*.

The fcx are commonly negligent, either inavojding
the remote'caufes, or in moderating the firft beginnings
of this difeafe. It is by fuch neglect that it fo frequent"
ly becomes , and of difficult cure ; and the fre-

:t repetition of a copious menftruation. may be
mnfidered. ns n. cnufe of great laxity in the extreme vef-
fcls of the uterus.

DGCCCLXXXI.

* '," " "• ;":-Ht give little {Itmulus arc manna, oil, tamarinds,
• mi'I-.l iubllanr.es. Aloetic and other ciraftic purges,
muft be carefiillf avoided. Rhubarb, in moderate dotes t is only
acimifTibls in cafes where there is an evident atony of the ftomacfa or
rnr! in tlvfe cafes it ought to be given in fubitance, or in
'•ifufjon. The fpirituous and vinous tinctures of it arc
ahfol in menorrhagia. A table- fpo'onful of the

;=?, taken occafionally, will fulTiciently obvj ; cofr
tlvencfv, without giving much llimulas :
^> Man. opt. ^ii.
Ol. ricini ^i.
Svr. rofar. Joint. |i.
n. tartar. 5fs,

O F P H Y S 1 a 15

DCCCCLXXXI.

When the coming on of the menftruiition has been
preceded by. feme diforder in other parts of the body
and is accompanied wit;h pains of the back, Tefembling
parturient pains, together with febrile fymptoms,
when at the fame time the flow Teems 'to be copious,
then a bleeding at the arm may be proper, but it is
not often rtecefiary ; and it will in rnoft cafes be fufft-
cient to employ, with great attention and diligence,
thofe means for moderating the difcharge which have
been mentioned in the iaft paragraph.
DCCCCXXXII,

When the immoderate flow of the menfes {hall feem
to be owing to a laxity of the veffels of the uterus, as
may be concluded from the general debility and laxity
of the pe: Ton's habit; from the remote caufes that have
occafioned the difeafe (DCCCCLXXVIII. ) from the ab-
fence of the fymptoms which denote increafed action
in the vefTels of the uterus (DCCCCLXXI.) from the fre-
quent recurrence of the dife.de ; and particularly from
this, that in the intervals of menflruation the perfon
is liable to a leucorrhcea ; then in fiich cafe the difeafe
is to be treated, not only by employing all the means
mentioned in DCCCCLXXX. for moderating the heraor-
rhagy, but alfo by avoiding all irritation, every irrita-
tion having the greater effect in proportion as the vef-
fels have been more lax and yielding. If, in fuch a
cafe of laxity, it; ihali appear that forn up 'of irri-

tation concurs, opiates may be employed to moderate
the difcharge ; but in ufmg thefe, much caution i
quifite*.

If, not with (landing thefc me^fares having been ta-
ken, the difcharge {hall prove very large, aitdngentsf ,

both

* Opiates ufed too liberally, generally increafe the difchavg-
;:e of their very great power in relaxing the wlu

f >ents fur internal ufe are, alum, catechu tinch:

vofes, &c. Tea v-ia'ns of alum, and as much catechu may be given
i'.i powder, every f.vo or three hours, with three* or four fpoonfuls

16 PRACTICi;

"both external and internal, may be employed. In

fuch cafes, may fmall dofes of emeticesbe of fervice ?

DCCCCLXXXIII.

When the menorrhagia depends on the laxity of the
uterine veffels, it will be proper, in the intervals of
menilruation, to employ tonic remedies ; as cold bath-
ing and chalybeates*. The exercifes of geftation, al-
fo, maybe very ufcfal,both forurengtbening the whole
fyftem, and for taking off the determination of the
blood to the internal parts.

DCCCCLXXXIV.

The remedies mentioned in thefe twolafl paragraphs,
may be employed in all cafes of menorrhagia, from
whatever caufe it may have proceeded, if the difeafe
ihall h.ive already induced a conliderable degree of
debility in the body. * .

CHAP.

of tincture of rofes to wafh it down. The bark is fometimcsof ufc
in thefe cafes, cfpecially when joined with alum. The external ap-
plications are, cold clothes foaked in vinegar and water applied to
the lower region of the abdomen, or to the pudenda ; or a ftrong
decoclion of oak-bark, with an ounce of alum diflbived in every pint
of it, may be applied cold to the fame parts.
k The following form is very convenient.
J$>, Rubigin. ferri. 311,

Corr. Peruv. §u

Syr. Simpl, q. f.

M. f. Elea.

The dofe of this eledluary is to be varied according to the conflitu-
tion ; the fize of a nutmeg twice a day is ufually given.

The bed forms of chalybeates, in thefe cafes, are the mineral wa-
ters which contain iron diffolved by fixed air. Chalybeate waters
mould not, in this difeafe, be drank in fuch large quantities as to
pafs off by {tool. A jill taken every three or four hours throughout
the day, with a fpoonful of port wine, is more efficacious than a
pint, ur even a quart, taken at once in the morning. The dofe,
however, of thefe waters, varies according to the ftrength of the
particular water we ufe. Along with the chalybeate water, a fcru-
ple, or half a drachm of Peruvian bark may be given twice a day. —
The following form is very agreeable, and is at the fame time fmgu-
larly efficacious :

dFPHtSIC. 17

CHAP. VII.

OF THE LEUCORRHCEA, FLUOR ALBUS, OR
WHITES. , ,

DCCCCLXXXV.

EVERY ferous or puriform difcharge from the va-
gina, may be, and has been, comprehended un-
der one or other of the appellations I have prefixed
to this chapter. Such discharges, however, may be
various ; and may proceed from various fources, not
yet well afcertained : but I confine myfelf here to treat
of that difcharge alone which may be prefumed to
proceed from the fame vefTcls, which, in their natural
Itate, pour out the menfcs.

DCCCCLXXXVI.

I conclude a difcharge from the vagina to be of this
kind*; i. From its happening to women who arefub-
ject to an immoderate flow of the menfes, and liable
to this from caufes weakening the veflels of the uterus,
2. From its appearing chiefly, and often only, a lit-
tle before, as well as immediately after, the flow of the
menfes. 3. From the flow of the menfes being di-
mini fried, in proportion as the Icucorrhoea is increafed*
4. From the leucorrhcea continuing after the menfes
have entirely ceafed,and with fomc appearance of its
obferving a periodical recurrence. 5. From the leu-

C corrhcea

£. Extrad. cort. Perur. §i.
Extract. Campechcnf.
Extract. Glychyrrh. a a 3jfs.
Mucilag. Gum, Arab. q. f.
M. f. Elea,
The dofc is half a drachra or two fcruples twice a-day.

* The young pra&itioner ought to pay great attention to the
diagnoliics of the leucorrhcea delivered in this article.

i8 PRACTICE.

corrhcea being accompained with the effect of the
menorrhagia (DCCCCLXXII. DCCCCLXXIH.) 6. From
the difcharge having been neither preceded by. nor
accorrpained with, fymptoms of any topical afFe&ions
of the uterus. 7. From the leuccrrhcea not having
appeared foon after communication with aperfon who
might be fufpecled of communicating infection, and
from the full appearance of the diieaie not being ac-
companied with any inflammatory auection of ihe pu-
denda*.

DCCCCLXXXVII.

The appearance of the matter discharged in the
leucorrbcea, is very various with refpeclto confidence
and colour ; but from thefe appearances it is not al-
ways p-flible to determine concerning its nature, or
the particular fourcefrom whence it proceeds.
DCCCCLXXXVIII.

The leucorrhcea, of which I am to treat, as afccr-
tained by the feveral circumftances DCCCCLXXXVI. feems
to proceed from the fame caufes as that fpecies of me-
norrhagia which I fuppofe, to arife from the laxity of
the extreme vefiels of the uterus. It accordingly of-
ten follows, or accompanies fuch a menorrhagia ; but
though the leucorrhcea depends chic-fly upon the laxi-
ty mentioned 5 it may have proceeded from irritations

inducing

* Nothing is more frequert with ignorant practitioners than to
mulakea gonorrhoea for a leucorrhcea. Women in general give the
name of whites to a gonorrhoea, and therefore the unvvaiy p>
tioner may the more eafily be rmfled. The diftiaguiming chare clc-
riftic of gonorrhoea is, as the author fays, an inflammatory affection.
of the pudenda; but, as few women will fuffer an infpe&ion of the
parts, we mull pay fome attention to the concomitant fymptoms.
The running in a gonorrhoea is condant, and only in fm:;!! quanti-
ties ; in a leucorrhcea the difcharge is inconilant, and in tarie
Quantities. The other diflinguifhing marks of a gonorrhoea
fmarting in making water, itching of the puderidi, Jncreafed incli-
nation tor vencry, a fwelling of the lubia and of the glands about
the groin. Some authors mention the c lour of the dffchdt ged mat-
ter as a diilinguilhing mark j this, however, is inconilant.

O F P II Y S I G. 19

inducing that laxity, and feems to be always increafed
by any irritations applied to the uterus.
DCCCCLXXXIX.

Some authors have aliedged that a variety of cir-
cumftances in other parts of the body may have a
mare in bringing on and in continuing this atFection of
the uterus now under coniideration: but I cannot dif-
cover the reality of thofe caufes ; and it feems to me,
that this leucoi rhcea, excepting in fo far as it depends
upon a general debility of the iyllem, is always prima-
rily an affection of the uterus ; and the affections of
other parts of the body which may happen to accom-
pany it, are for the mod part to be confidcred as ef-
fects, rather than as caufes.

DCCCCXC.

The effects of the leiicorrhcea are much the fame
with thofe of meliorrhagia ; inducing a general debi-
lity, and, in particular, a debility in the functions of
the ftomach. If, however, the leticorrhcea be mode-
rate, and be not accompanied with any confiderable
degree of menorrhagia, it may often continue long
without inducing any great degree of debility, and it
is only when the difeharge has been very copious as
well as conitantj that its effects in thai way are very
remarkable.

DCCCCXCI,

But, even when its effects upon the whole body
are not very considerable, it may ilill be f applied to
weaken the genital fyftem ; and it feems fufficicntly
probable that this difcharge may often have a fhare in
occafioning baireniiefs.

DCCCCXCII.

The matter difcharged in the leucorrhoea, is at firll
generally mild : but after fome continuance of the
difeafe, it fometimes becomes acrid* ; and by irmat-

G 2 . ing

The young pra&IKoner muH:. not conclude too hadily that an.

20 PRACTICE

ing, or perhaps eroding, the fur faces over which it
paffes, induces various painful diforders.
DCCCCXCIII.

As I have fuppofed that the leucorrhcea proceeds
from the fame caufes as that fpecies of menorrhagia
which is chiefly owing to a laxity of the uterine verTds,
it mult be treated, and the cure attempted, by the
fame meaus as delivered in DCCCCLXXXII for the cure
of menorrhagia, and with lefs referve in refped of the
ufe of aftringents*.

DCCCCXCIV.

As the leucorrhcea generally depends upon a great
lofs of tone in the veifds of the uterus, the difeafe has
been relieved, and fometimes cured by certain ftimu-
lant medicines, which are commonly determined to
the urinary paffages, and from the vicinity of thefe are
often communicated to the uterus. Such, for exam-
ple, are cantharides, turpentine, and other balfams of
a fimilar nature -jr.

CHAP.

ulcer exids in the uterus when the matter discharged is acrid. — ?
Practice has offered many inftan-ces where the matter has excoriated
the pudenda, and yet no ulcer exifted*

* The electuary mentioned at the end of the laft note on Article
983, has been found very efficacious in fome cafes of leucorrhcea., —
It's dofe may be increafed to a drachm thrice a-day, either fwallovr-
ed as a bolus, or diffolved in an ounce of pure water, and half an
ounce of pure cinnamon-water. The chalybeate waters are ufed in
this, as well in the former difeafe ; and they may be ufed in the
manner above mentioned. Practitioners recommend, in thefc
cafes, a nutritive but not a heating diet, as mucilaginous broths
made with rice, cfpecially veal-broth, jellies of all kinds, except thofe
that are high feafo-icd. Port-wine muft be prefcribed in a mode-
rate quantity, according to the habits of the patient.

•j* The prince here recommended is not without danger, and

muft not be. followed except with great caution and circumspection.

When the other means fail in producing relief, we may then have

recourfc to thefc balfamics, or join them to the tonic aftringents, as,

JJ> Gum. oliban.

Terebinth, venet. t

O F P H Y S I C. 21

CHAP. VIII.

OF THE AMENORRHCEA, OR INTERRUP-
TION OF THE MENSTRUAL FLUX,

DCCCCXCV.

WHATEVER, in a fyftem of methodical nofolo-
gy, may be the fitteft place for the amenor-
rhcea, it cannot be improper to treat of it here as an
object, of practice, immediately after having confider-
ed the menorrhagia.

DCCCCXCVI.

The interruption of the menftrual flux is to be con-
fidered as of two different kinds ; the one being when
the menfes do not begin to flow at that period of life
at which they ufually appear; and the other being
that when, after they have repeatedly taken place for
fonie time, they do? from other caufes than concep-
tion, ceafe to return at their ufual periods ; The form-
er of thefe is named the retention, and the latter the
fi'fpreffion, of the -menfes.

DGCCCXCVII.

As the flowing of the menfes depends upon the

force

Terra, japonic, a a. 51.

Sal, martis 31*5.

M. f. mafTa in pilulas equales.

No. 60. dividend.

Two or three of thefc pills may be given twice a-ctav or oftener* —
Some praclitioneis have ilrongly recommended the following emul-
fion :

E» Balfam. copaivi. ^i.

Vitel. ovi No. t.

Tere in mortar, marmor. et adde gradatim.

Aq. font. §vii.

Svr. Simpl. ^i«

M. f.-'Emulf.

The dofe of this emuHiQii is two or three fpocnfuls three oribur
times a-day. *"

22 PRACTICE

force of the uterine arteries impelling the blood into
their extremities, and opening tbete ib as to pour out
red blood ; fo the interrupuon of the menftrtml flux
rauPc depend either upon the want of due force in the
action of the uteiine arteries, or upon fome preternatu-
ral refinance in their extremities. The former Imp-
pole to be the, moil ufiiul cauiV of retention, the latrer
the mod common caufe offupprelTion ; and of each of
thtfe I lliall now treat more particularly.
DCCCCXCVIII.

The retention of the menfes, the emanfio menfium
of Latin writers, is not to be coniidered as a dii'eaie
merely from the menfes not flowing at that period
uhich is ufual with moft other women. This period
is fo different in diffeient women, that no time can be
precifoly alligncd as proper to the lex in general. —
In this climate, the menfes ufually appear about the
of fourteen : but in many they appear more early,
and in many not till the fifteenth year : in which laft
caf~ it is often without any diforder being thereby oc-
cafioned. It is not therefore from the age of the
perfon that the retention is to be coniidered as a dif-
eaft ;; and it is only to be considered as fuch, when
cb-jutthe time the menfes ufually appear, fome difor-
, arife in other parts of the body which may be im-
puted to their retention; being fuch as, when arifmg
at this period, are known from experience to be re-
moved by the flowing of the menfes.
DCCCCXCIX.

Thefe diforders are, a fluggiihnefs, and frequent
fenfe of latitude and debility, with various fymptoins,
of dyfpepfici ; and fome times with a preternatural ap-
petite*. At the fame time the face lofes its vivid co-
lour,

* This is a very extraordinary fymptom, \vh:ch has not hitherto
been explained. It fomctimes accompanies every ceflation of the
uterine diicharge, but frequently appears in the mod violent degree
in pregnancy. In young women, the appetite for chalk, lime, rub-

OF PHYSIC. . *$

lour, becoires pale, and fometimes of a yellowifii hue ;
the whole body becomes pale and flaccid; and the
feet, ana j..*v hap> ado a great part of the body, become
affecled \vith cedematous fwelling. The breathing is
hurried by any quick or laborious motion of the body
and the heart is liable to palpitation and fyncope. —
A headach fometimes occurs ; but more certainly
pains of the back, loins, and haunches*.

M.

Thefe fymptoms, when occurring in a high degree,
conilimte the chlorojls of authors, hardly ever appear-
ing feparate from the retention of the menfes ; and,
attending to thefe fymptoms, the caule of this reten-
tion may, I think, be perceived.

Thefe fymptoms manifeftly (how- a confiderable lax-
ity and flaccidity of the whole fyftem ; and therefore
give reafon to conclude, that the retention of the men-
fes accompanying them, is owing to a weaker aclion
of the vefTels of ihe uterus; which therefore do not
impel the blood into their extremities with a force
fufficient to open thefe, arid pour out blood by them.

MI.

How it happens that at a certain period of life m
flaccid; iy of the fyftem arifes in young women not
originally afFe&ed with any fuch weaknxrfs or laxity ^
and of which but a little time before, they h.id given
no indication, may be diiBcult to explain ; but I
wouid attempt it in this wuy.

Ab a certain (late of the ovaria in females, prepares

d::pnie3 them to the cxerclie of veiiery, about the

very period at which the menfes ill ft appear, it is to be

pre-

bifli, charcoal, and various abforbents, is the moft prevalent. Stall),
and his followers, made great life of this circnmfUnce in fuppcrtin^
their favourite opinion of the vis inedicatnx naturce.

Thefe pains are not properly fymptoms of the tlifeafe, but
but prognoiltcs of the efforts nature makes to remove the difeafe :
They are fymptoms of the vis medicatrix.

2/r PRACTICE

prefumed, that the flate of the ovaria and that of the
uterine vcfiels are in fome meafure connected toge-
ther ; and as generally fymptoms of a change in the
Hate of the former appear before thoie of the latter,
it may be inferred that the flate of the ovaria has a
great mare in exciting the action of the uterine veilcls
and producing the mentlrual flux. But analogous to
what happens in the male fex, it may be prefumed,
that in females a certain ftate of the genitals is necef-
fary to give tone and tcnfion to the whole iyftem ; and
therefore that, if the flimulus ariilng from the geni*
tals be wanting, the whole fyftem may fall into a tor-
pid and flaccid fcate, and from thence the chlorpfisand
retention of the mcnfcs may arife.

MIL

It appears to me, therefore, that the retention of
the menfes is to be referred to a certain flate or affec-
tion of the ovaria: but what is precifely the nature of
this affection, or what are the caufesof it, I will not
pretend to explain ; nor can I explain in what man-
ner that primary caufe of retention is to be removed.
In this, therefore, as in many other cafes, where we
cannot affign the proximate caufe of difeafes, our in-
dications of cure mull be formed for obviating and
removing the morbid effects or fymptoms which ap-
pear.

,MIIL

The effects, as has been faid in M. confift in a ge-
neral flaccidity of the fyftem, and confequently in a
weaker action of the vellels of the uterus ; fo that this
debility may be coniidered as the more immediate
caufe of the retention. This, therefore, is to be cur-
ed by reftoring the tone of the fyilem in general, and
by exciting the action of the uterine veffels in parti-
cular.

MIV.

The tone of the fyftem in general is to be reftored

by

OF PHYSIC. 23

by exercife, and in the beginning of the difeafe, by
cold bathing. At the fame time, tonic medicines*
may be employed ; and of thefe the chaiybeutes have
been chiefly recommended.

MV.

The acYion of the veiTels of the titerus may be ex-
cited :

ift, By determining the blood into them more co-
pioufly ; which is to be done by determining the blood
into the defending aorta, by purging, by the exer-
cife pf walkingf, by fiiaion, and by warm bathing of
the lower extremities. It is alfo probable that the
blood may be determined more copioufly into the hy-
pogaftric arteries which go to the uterus, by a com-
preffion of the iliacs ; but the trials of this kind hi-
therto made have feldom fucceeded.

MVI.

idly, The action of the uterine vefTels may be ex-
cited by ftimulants applied to them. Thus thofe
purgatives which particularly fthnulate the inteflinum
reclumj, may alfo prove ftin-ulant to the uterine vef-

VOL. II. D ft Is

* Forms of the tonic medicines have been given in Come of the
preceding notes. The electuary in the note on article 983. is fre-
quently ufed with fucceis. In this cafe, we mult not uie a ringents,
but tonics, and confequently only fuch tonics as are not aflringcnts,
at lealt in a high degree. I he fimple bitter tonics frequently an-
fvver where the fymptoms are not fevere. The infufum gentians
compofiturn of the new London Pharmacopoeia is a good formula.
The dofe of it is two ounces twice a clay, or oftener, if the ilomach,
can bear it. Chalybeates are abfolutely neceflary if the difeafe with-
ftands the ufe of bitters; they may be given iu any of the forms
mentioned in the preceding notes.

f Dancing is alfo a proper exetcife in this difeafe-
j The ftimulant purges are in general the draftic refins, as Soem-
mony, Aloes, &c. Various formulae of them have been recommend-
ed in thefe cafes ; the pilulx Rufi is commonly ufed with good tf-
fe&. It may be given in the quantity of half a drachm, or, in ftrong;
constitutions, two fcruples. It ought not to be repeated above
twice a week ; and, in the intermediate days, we may employ the
tonic medicines above mentioned. The Pilulse ecphradticse of the

26 PRACTICE

fels connected with thofe of the reftum. The exer-
cife of venery certainly proves aflimulus to the vefTels
of. the uterus ; and therefore may be ufeful when, with
propriety, it can be employed. The various medi-
cines recommended as flimulants of the uterine vef-
feis, under the title of Emmenagogues, have never
appeared to me to be effectual ; and i cannot perceive
that any of them are poiTeiTed of a fpecific power in
this refpect. Mercury, as an univerful ftimulant, may
aft upon the uterus, but cannot be very fafely em-
ployed in chlorotic perfons. One of the moll power-
ful means of exciting the a&ion of the verTels in every
part of the fyilcm is, the elecl.ical mock ; and it has
often been employed with fuccefs for exciting the vef-
fels of the uterus.

MVIL

The remedies (MIII MVI.) now mentioned,

are thofe adapted to the retention of the menfes; and I

am

Edinburgh Pharmacopoeia is another very effectual medicine in thefe
calcs. It's dofe is half a drachrn twice a week, if we intend to
purge b.iikly, but, by giving a fmaller quantity as ten, twelve, or
fifteen grains once a-ciay, a conttant fttmuius is preferved, which
forne 'practitioners prefer. The following pills are alfo much re-
commended :

&. Pil. Giimmof.

Aloes Socotorin, a a, 311,

Vin. AJcet. q f.

M. f. Mafia in pilulas 48 dividend.

The dofe is 3 or 4 piils at bed time.

The Tinctura facra is alfo frequently ufed as a brifk purge in thefc
cafes ; it's dofe for thispurpoie. mult not be lefs than an ounce and
a half in mod habits ; but a Ihong conftitution will require two
ounces or more. Oilier ftimulants than purges have been employed
in amenorrhoca, as the tinclura fabina compolita of the new Lonaon
Pharmacopoeia ; it's dofe is thiity or forty drops, in any fuitable ve-
hicle, as the tin&ura mynhac of the fame Pharmacopoeia, in dofes
of twenty or thirty drops, is often recommended on the authority
of Boerhaave.

OF PHYSIC. 27

am next to consider the cafe ^fuppreffion. In enter-
ing upon this, I mud ohferve, that every interruption
of the iiux, after it has once taken place, is not to be
conlidered as a cafe of fuppreffion. For the tiux, up-
on its firfl appearance, is not always immediately eila-
blifhed in its regular courfe ; and therefore, if an in-
terruption happen foon after the firfl appearance, or
even in the courfe of the firft, or perhaps fecond year
after, it may often be confidered as a cafe of reten-
tion, efpecially when the difeafe appears with the
fymntoms peculiar to that (late.

MV1II.

Thofe which may be properly confidered as cafes
offupprefiion, are fuch as occur after the flux has been
for fome time efhiblifhed in its regular courfe, and in
which the interruption cannot be referred to the cr.uf-
es of retention (MII, MIU.) but niufl be impute
fome refinance in the extremities of the veifels of the
uterus. Accordingly, \ve often find the fuppreffion
induced by cold, fear, and other caufes which may
produce a confr.ricr.ion of thefe extreme veflels. Some
phylicians have fuppofed an obilructing lentor of the
fluids to occafion the refinance now mentioned : but
this is purely hypothetical, without any proper evi-
dence of the fact; and it is beilues, from other conii-
derations, improbable.

MIX.

There are indeed fome cafes of fuppreffion that feeni
to depend upon a general debility of the fyftem, and
confequently of the veflels of the uterus. Eat in fuch
cafes, the fuppreffion always appears as fymptomatic of
other affections, and is therefore not to be confidered
here.

MX.

The icHopathic cafes of fuppreffion (MV-II i .) " feldom
continue long without being attended with various
fymptoms or diforders in different parts of the body ;

D 2 very

2$ PRACTICE

very commonly arifing from the blood which fhould
haAc puffed by the uterus, being determined more co-
picufly into other parts, and very often with fuch
force as to produce hemorrhagies in thefe. Hence
hemorrhagies from the nofe, lungs, ftomach, and other
parts, have appeared in confequence of fupprefTed
menfes. B~fides thefe, there are commonly hyiteric
and dyfpeptic fymptoms produced by 'he fame caufe ;
raid frequently colic pains, with abound belly.

MXI.

In the idiopathic cafes of fupprcffion, (MVII.) the
indication of cure is to remove the conftridion affec~l-
ing the extreme vefTels of the uterus; and for this pur-
pole, the chief remedy h warm bathing applied to the
rci/ic n of the -uterus. This, however, is not always
etixctua], and I do not know of any other remedy a-
dapted to the indication. Befides this, we have per-
haps no other means of removing the conftridion in
fault, but that of increafing the action and f;>rce of
the veffels of the uterus, fo as thereby to overcome the
x\- litl an ce or conduction of their extremities. This
therefoic is to be attempted by the fame remedies in
the cafe of fupprefiion, as thofe prefcribed in the cafes
of retention (MIV — MVI.) The tonics, however, and
cold bathing (MIV.) ftem to be lefs properly adapted
to the cafts of fupprefiion, and have appeared to me
oj ambiguous eftecl*.

MXII.

* The Emenagogues enumerated in the note on article 100$,
are move efficacious in thtfe cafes than the tonics and chalybeates
mentioned in the note on article 1004, for this reafon, that the
fuppreffion of the n;c.,frs depends more on the conftri&ion, than on
a laxity cf the extreme veflcls. Some cafes indeed, occur, where a
lax habit is the caufe of fuppreflion, but they are rare- The phy-
iicians ought to be attentive in difcriminating fuchc^fes, becaufe a
liberal ufe of forcing emenagogu:-s is always hurtful in them j they
can cnir be relieved by tonics, and efpecially by chalybeates.

O F P H Y S I C. 29

MXII.

It commonly happens in the cafes of fupprefilon,
that though the menfes do not flow at their ufual pe-
riods, there are often at thofe pe.iods fomc marks of
an effort having a tendency to produce the difcharge.
It is therefore at thofc times efi;ecially when the ef-
forts of the fyftem are concurring, that we ought to
employ the remedies for curing a fuppreffion ; and it
is commonly fruitlefs to employ the-n at other times,
unlefs they be fuch* as require fornc continuance in
their ufe to produce their effects.

Mxnr.

Nearly fimilar to the cafes of fuppreflion, are thofc
cafes in which the menfes flow after longer intervals,
and in leffer quantity than ufual; and when thefe caf-
es are attended with the diforders in the fyitem (MX.)
they are to be cured by the fame remedies as the caf-
es of entire fuppreffion.

MXIV,

It may be proper in this place to take notice of the
defmenorrhea, or cafes of menftruation in which the
menfes feern to flow with difficulty, and are accompa-
nied with much pain in the back, loins, and lower
belly. We impute this diforder partly to fome weak-
er adlion of the veffels of the uterus, and partly? per-
haps more efpecially, to a fpafm of its extreme veffels.
We have commonly found the difcafe relieved by em-
ploying fome of the remedies of fuppreffion immecli-
ately before the approach of the period, and at the
fame time employing opiates.

CHAR

•'• Viz, tonics or alterants.

PRACTICE

CHAP. IX.

OF SYMPTOMATIC HEMORRHAGIES.

MXV.

HAVE thought it very improper in this work, to
treat of thofe morbid.afFe&ions that are almoft al-
ways fymptomatic of other more primary difeafes ;
and this for leveral reafons, particularly becaufe it
introduces a great deal of confufion in directing prac-
tice, and leads phylicians to employ palliative mea-
fures only. I (hall here, However, deviate :i little from
my general plan, to make foine reflections upon
fyinptomatic hemorrhagies.

MXVI,

The hemorrhagies of this kind that efpecially de-
ferve our notice, are the Hematemefis, or Vomiting
of Blood ; and the Hematuria, or the Voiding of
Bloocl from the urinary pafTage. Upon thefe I am
here to make ibme remarks ; becauie, though they
are very generally fymptomatic, it is poilible that they
may be f.-metirnes primary and idiopathic nfFedions ;
and'becaufe they have been treated of as primary dif-
cafes in almoil every iyftem of the practice of phy-
ilc.

SECT. I.

OF THE HEMATEMESIS, OR VOMITING
OF BLOOD.

. MXVII.

HAVE faid above (in DCCCCXLV.) in what man-
ner blood thrown out from the mouth may be

known

OF PHYSIC; 31

known to proceed from the ftomach, and not from
the lungs : but it may be proper here to lay more par-
ticularly, that this may be certainly known, when the
blood is brought up manifeftly by vomiting without
any coughing ; when this vomiting has been preceded
by fome fenie of weight, anxiety, and pain, in the re-
gion of the ftomach ; when the blood brought up is
of a black and grumous appearance, and when it is
manifeftly mixed with other contents of the ftomach ;
we can feldom have any doubt of the fource from
whence the blood proceeds, and therefore of the exift-
ence of the difeafe we treat of.
MXVIII.

We muft allow it to be poilible that a plethoric
ftate of the body from general caufes may be accom-
panied with caufes of a peculiar determination and
aiHux of blood to the ftomach, fo as to occafion an
hemorrhagy there, and thence a vomiting of blood j
and in fuch a cafe this appearance might be confider-
ed as a primary difeafe. But the hiitory of difeafes
in the records of phyfic, afford little foundation for
fuch a fuppofition ; and on the contrary, the whole
of the inftances of a vomiting of blood which have
been recorded, are pretty manifeftly fymptomatic of a
more primary affection.

Of fuch lymptomatic vomitings of blood, the chief
inftances are the following.

MXIX.

One of the moft frequent is that which appears in
confequence of a fuppreffion of an evacuation of blood
which had been for fome time before ellablillied in a-
nother part of the body, particularly that of the men-
lirual fiux in women.

MXX.

There are inftances. of a vomiting of blood happen-
ing from the retention of the menfes : but fuch indanc.es
arc very uncommon j as a retention of the menfes

rarely

32 PRACTICE

rarely happens -in confequence of, or even with, a ple«
thoric ftate of the body ; and as rarely does it produce
that, or the hemorrhagy in queftion.

There are inftances of a vomiting of blood happen-
ing to pregnant women ; that might therefore alfo be
imputed to the fupprefiion of the menfes, which hap-
pens to women in that (late. There have indeed been
more inftances of this than of the former cafe ; but
the latter are ftill very rare : for although the blood
which ufed to flow monthly before impregnation, is,
upon this taking place, retained, it is commonly fo en-
tirely employed in dilating the uterine veflels, and in
the growth of the foetus, that it is feldom found to
produce a plethoric ftate of the body? requiring a vi-
carious outlet*

The vomiting of blood, therefore, that is vicarious
of the menftruai flux, is that which commonly and al-
mofl only happens upon a fuppreflion of that flux, af-
ter it had been forfome time eftabliihed.

MXXL

When fuch a fuppreflion happens, it may be fup-
pofed to operate by inducing a plethoric ftate of the
whole body, and thereby occasioning hemorrhagy from
other parts of it ; and hemorrhagies from many dif-
ferent parts of the body have been obferved by phy-
ficians as occurring in confequence of the fuppreflion
we fpeak of. It is however the great variety of fuch
hemorrhagies, that leads me to think, that with the
plethoric ftate of the whole body there muft be always
ibme peculiar circumftances in the part from which
the blood flows, that determine its afflux to that par-
ticular, often fingularly odd- part ; and therefore, that
fuch hemorrhagies may from thefe circumftances occur
without any confiderable plethora at the fame time pre-
vailing in the whole fyftem.

MXXIL

O F* P H Y S I & 33

MXXII.

It is to be obferved, that if we are to exped an he-
fcnorrhagy in confequence of a fupprefiion of the menfes
inducing a plethoric ftate of the fyftem, we fhould ex-
pect efpecially an hemoptyiis, or hemorrhagy from the
lungs, as a plethora might be expected tofnovvits effects
efpecially there ; and accordingly, upon occaiion of
fupprefled menfes, that hemorrhagy occurs more fre-
quently than any other : but even this, when it does
happen, neither in itscircumftances nor its confequen-
ces, leads us to fuppofe, that at the fame time any con-
fiderable or dangerous plethora prevails in the body*

MXXIII.

Thefe coniiderations in MXXI. MXXII. will, I ap-
prehend, apply to our prefent fubject; and I would
therefore allcdge, that a hematemefis may perhaps
depend upon particular crrcumftanees of the ftomach
determining an afflux of blood to that organ, and may
therefore occur without any Copfiderable or dangerous
plethora prevailing in the fyftem. What are the cir-
cumftances of the ftomach, which upon the occaiion
mentioned, may determine an afflux of blood to it, I
cannot certainly or clearly explain ; but prefume that
it depends upon the connection and confent which we
know to fubfift between the uterus and the whole of
the alimentary canal, and efpecially that principal part
of it the ilomach*

MXXIV.

From thefe reflections, we may, I think, draw the
following conclufions :

I. That the hematemeiis we fpcak of is I ,ver
a dangerous difeafe.

II. That it will hardly ever require the remedies fait*
ed to the cure of a&ive hemorrhagy j and at lead that
it will require thefe only in thofe unufaal cafes in
which there appear ftrong marks of a general plethora,

VOL, II. E and

34 P R A C T I G E

and in which the vomiting of blood appear $ to be con-
iiderably active, very profufe, and frequently recurring.

III. That a vomiting of blood from fuppreiTed menf-
es, ought feidom to prevent the ufe of thefe remedies
of amenorrhoea, which might be improper in the cafe
©f an active idiopathic hemorrhagy.
MXXV.

Another cafe of fymptomatic hematemefis quite
analogous to that already mentioned, is the hemate-
rnciis following, and feemingly depending upon, the
fuppreilion of an hemorrhoidal flux, which had been
eilabliihed and frequent for fome time before.

This may perhaps be explained by a general ple-
thoric ilate induced by fuch a fuppreflion ; and indeed
fome degree of a plethoric ilate muft in fuch a cafe be
fuppcfed to take place ; but that fuppofition alone
\villnot explain the whole of the cafe ; for a general
plethora would lead us to expect an hemoptyfis (MXX-
ii.) rather than an hematemefis ; arid there is there-
fore fomething ft ill wanting, as in the former cafe, to
explain the particular determination to theftornach.

Whether fuch an explanation can be got from the
connection between the different parts of the fangui-
ferous veffels of the alimentary canal, or from the
connection of the whole of thefe vefTels/with the ve-
na portarum, 1 lhall not venture to determine. But
in the mean time I imagine that the explanation re-
quired is rather to be obtained from that connection
of the ftbmach with the hemorrhoidal affection that I
have taken notice of in DCCCCXLVI.
MXXVI.

However we may explain the hematemefis occafi-
oned by a fupprcffion of the hemorrhois, the conge-
lations in MXXI. Mxxn. will apply here as in theana-
logous cafe of hematemefis from fupprefTed menfes ;
and will therefore allow us alfo to conclude here, that

the

OFF H Y S I C. 35

the diicafc we now treat of will feldom be dangerous,
and will feldom require the lame remedies that idio-
pathic and a&ive hemorrhagia does,
MXXVII.

The cafes of hematcmefis already mentioned, may
be properly fuppofed to be hemorrhagies of the arterial
kind ; but it is probable that the ftomach is alfo liable
to hemorrhagies of the venous kind. (DCCLXVIU.)

In the records of phyfic there are many in fiances of
vomitings of blood, which were accompanied with
a tumefied fpleen, which had comprefled the vas
breve, and thereby prevented the free return of venous
blood from the ftomach. How fuch an interruption
of the venous blood may occafion sn hemcrrhagy
from either the extremities of the veins them/elves,
or from the extremities of their correfpondent arte-
ries, we have explained above in DCCLXIX. and the
hiftories of tumefied fpleens comprefiing the vafa bre-
via, afford an excellent illuflration and confirmation
of our doctrine on that fubjecl:, and render it fuffici-
ently probable that vomitings of blood often arife
from fuch a caufe.

MXXVIJI.

It is alfo poffible, that an obftrucrion of the liver,
refifling the free motion of the bluod in the vena por-
tarum, may fonietimes interrupt the free return of
the venous blood from the veflels of the ftomach, and
thereby occafion a vomiting of blood ; but the in-
fiances of this are neither ib frequent nor fo clearly
explained as thofe of the former cafe.
MXXIX,

Befides thefe cafes depending on the ftate of the li-
ver or fpleen, it is very probable that other hemor-
rhagies of the ftomach are frequently of the venous,
kind,

The difeafe named by Sauvages Mehena, and by
j- 2 other

36 P R A C T I C E

other writers commonly termed the Morbus Niger
(DCCLXXII.) coniifting in an evacuation either by vo-
miting or (tool, and fometimes in both ways, of a
black and grumous blood, can hardly be otherwife
occaiioned, than by a venous hemorrhagy from fome
part of the internal furface of the alimentary canal.

It is, indeed, poffible, that the bile may fometimes
put on a black and vifcid appearance, and give a real
foundation for the appellation of an Atra Bilis : but
it is certain, that infiances of this are very rare ; and
it. is highly probable that what gave occaiion to the
notion of atra bilis among the ancients, was truly the
appearance of blood poured into the alimentary canal
in the manner I have mentioned ; and which appear-
ance, we know, the blood always puts on when it has
ftagnared therefor any length of time. I fuppofe it-
is now generally thought, that JBoerhaave's notion of"
fuch a matter exilling in the mafs of blood, is without
any foundation ; whilft, by directions in modern times,
it appears very clearly, that the morbus nigerprefent-
ing fuch an appearance of blood, always depends up-
on the effuiion and ftagnation I have mentioned.

MXXX.

From this account of the melaena it will appear,
that vomitings of blood may arife in confequence of
blood being poured out in the manner I have menti-
oned, either into the cavity of the ftomach itfelf, or
into the fuperior portions of the interlines, from whence
matters often pafs into the flomach.

MXXXI.

Both m the cafe of the Melaena, and in the analo-
gous cafes from affections of the fpleen or liver, it will
appear, that the vomitings of blood occurring muft be
confidered as. fymptomatic affections, not at all- to be
Created as a piimary active hemorrhagy, but by reme-
dies

OF PHYSIC. 37

dies, if any fuch be known, that may refolve the pri-
mary obftru&ions*.

MXXXIL

I believe I have now mentioned almoft the whole
of the caufes producing a hernatemefis ; and certainly
thecaufes mentioned, are thofe which mod common-
ly give occalion to that fymprom. Poffibly, however,
there may be fome other caufes of it, fuch as that iin-
gular one mentioned by Sauvages, of an aneurifm of

the

* This is doiibtlefs the moft rational practice, namely, to refolve
the obftru&ion which has occafioned the blood to be thrown or
driven to the inteftines. To difcover this primary obltruftion is,
however, extrenaely difficult; and, even when it is difcovered, it is.
frequently not eafilyrefolved ; in fuch cafes, therefore, we mull: ufe
the general remedies for removing the plethora, except laxatives,
, the operations of which, in general, derive the fluids to the intef-
tines. Sweating is perhaps the belt general evacuation for deter-
mining the fluids from the inteftines ; but it's ufe ought to be pre-
ceded by bleeding: and it ought not, in thefe cafes, to be excited
by naufeating dofes of emetics, as thefe produce the fame effect as
laxatives ; we mull therefore have recourfe to the light aromatics,
Jage, mint, balm, wine-whey, &c. Camphor and opium are alfo
proper fudoriiks in thefe cafes. They may be given together, as
in the following bolus :

.& Camphor, gr. vi.
Spr. vinigutt. x.
Opii pur. gr. i.
Conf, card. ^fs. vel. q. F.
M. f. bolus,

Some pra&itiontrs have recommended large quantities of fperma-
ceti in cafes of hernatemefis, and not without reafon. It may be
given in emulfions, with yolks of eggs, or in an ekauary. I mail
therefore add a formula of each.

&. Spermat. cet. |fs.
Vitel. ovi q. f.

Tere in mortar, marmoreo, et adde
Aiq. font. f}.
Styr. fimpl. ^i.
M. f. Emulf.

'The dofc of this emulfion is two or three table 'fpoonfulls every three
kourt,

38 P R A C T I C E

the aorta burfting in to the ftomach : and it is pofiiblc
that fome difeafes of other contiguous parts, which
have become clofely adhering to the ftomach, may ^
fometimes, by a rupture into the cavity of the fto-
rnach, pour blood into it, which is afterwards re-

jcded

§, Spermat. cct. gi,

Confcrv. roiar. ^ii.
o

Syr. fimp. ^i.
M. f.elea.

The dofe of this ele&uary is * tca-fpoonfull or two every two or
three hours.

If the hematemefis be violent, we muft have recourfe to fome of
the ilyptics and aftringents mentioned before in the cure of hemor-
rhage in genera!, as alum, catechu, kino, &c. of which I fliall fub-
joiiifomc formulae.

R. Alum. u(h gr. iii.
Kino 3fs.
M. f. Pulvis.

This powder may be icpeated every two hours, and three table-
fpoonfuls of the tincture of rofes may be given to wafli it down.

The ele&uarium japonicum of the Edinburgh Pharmacopoeia is
well calculated for thefe cafes ; it's dofe is a drachm and a half, or
two drachms. The extract qf logwood is fometimes ufed in thefc
dofes with confiderable fuccefs. It may either be given alone in
dofes of a fcruple each every three hours, or joined with alum, as in,
the following formula.

R. Extract, lign. Campechenf. 3fs.
Alum. uft. gr. iii
M, f. p ul vis.

This powder may be repeated every three hours; drinking after it
three tabie-fpoonfulls of the tindure of rofes : or a tea-cup full of
cold water, with twenty or thirty drops of the acid um vitriolicurn
dilutum, or as much as is fufficient to give an agreeable acidity.
All thtfe flyptica and aftringents are apt to produce coftivenefs
which muft be removed by emollient clylters, as laxative medicines
are, for the reafons above mentioned, generally hurtful in thefe ca-
fes. The young practitioner muft not trull to thefe medicines for
completely curing an hemorrhage from the inteftine* ; they are only
palHatives, and are of no other ufe than to check the violence of
the difchargc until the true caufe of the difeafe be difcovered ; and
the difcovery of this caufe mull be left to the fagacity of the phyl!->
<nan.

O F P H Y S I C. 39

je&ed by vomiting. It is pollible, alfo, that abfceiles
and ulceraiionsof the doinach itfelf, may fometimes
pour blood into its cavity to be thrown up by vomiting.
I did not think it neceflary among the iymptoma-
tic vomitings of blood, to enumerate thole from ex-
ternal violence, nor, what is analogous to it, that
which arifes from violent draining to vomit; which
laft, however, is much more rare than might be ex-
pected. In either of thefe cafes the nature of the uif-
eafe cannot be doubtful, and the management of it
will be readily underilood from what has been deliver-
ed above with refpect to moderating and retraining
hemorrhagy in general.

SECT II.

OF THE HEMATURIA, OR THE VOIDING

OF BLOOD FROM THE URINARY

PASSAGE.

MXXXIII.

IT is ailed ged, than an hernaturiahas occurred with-
out any other fymptom of an affedlion of the kidneys or
urinary palfages being prefent at the fame time ; and
as this happened to plethoric perfons, and recurred at
fixed periods, fuch a cafe has been fuppcfed to be an
inftance of idiopathic hematuria, and of the nature of
thofe active hemorrhagies I have treated of before.

MXXXIV.

I cannot pofitively deny the exiflence of fucli a
eafe; but mud obferve, that there are very few in-*
fiances of fuch upon the records of phyfic ; that none
have ever occurred to my obfervation, or to that of
my friends ; and that the oblervations adduced may
be fallacious, as I have frequently obferved an hema-
turia without fymptoms of oiher affection of the kid-
ney

40 PRACTICE

ney or urinary paffages being, for the time, prefent $
whilii, however, fits of a nephralgia calculofa hav-
imr, before, or foon after, happened, rendered it to me
fufficiently probable, that the hematuria was owing to
a wound made by a ftone prefent in fomepart of the uri-
nary paffages. MXXXV.

The exillcnce of an idiopathic hematuria is further
improbable, as a general plethora is more likely to
produce an hemopcylis (MXXII.) and as we do not
Well know of any circumstances which might deter-
mine more particularly to the kidneys. An idiopathic
hematuria, therefore, mull certainly be a rare occur-
rence ; and inflances of fymptomatic affections of the
fame kind are very frequent.

MXXXVI.

One of the moil frequent is, that hematuria which
attends the nephralgia calculofa, and feems manifeflly
to be owing to a Hone wounding the internal lurface
of the pelvis of the kidney or of the ureter. In fuch
cafes, the blood difcharged with the urine is
fometimes, of a pretty florid colour, but for the moft
part is of a dark hue : the whole of it is fome*
times diffufed or diffulved, and therefore entirely fuf-
pended in the urine ; but if it is in any large quan-
tity, a portion of it is depolited to the bottom of the
veffel containing the voided blood and urine. On
different occafions, the blood voided puts on different
appearances. If the blood poured out in the kidney
has happened to ftagnate for forne time in the ureters
or bladder, it is fometimcs coagulated, and the coa-
gulated partis afterwards broken down into a grumous
mafs of a black or dark colour, and therefore gives
the fame colour to the urine voided; or if the quan-
tity of broken down blood is fmall, it gives only a
browmfh urine refembling coffee. It fometimes alfo
happens, that the blood llagnuting and coagulating

in

OF PHYSIC. 41

$h the ureters, takes the form of thefe vefTeIs3 and is
therefore voided under the appearance of a worm ;
and if the coagulated blood happens to have, as it
may fometimes have, the glutten Separated from the
red globules, thcfe worm-like appearances have their
external furface whitim, and the whole feemingly
forming a tube containing a red liquor. I have fome-
times obferved the blood which had feemingly been
coagulated in the ureter^ come away in an almoft dry
ilate, refembling the half- burnt wick of a candle*.
MXXXVIL

Theiearethe feveral appearances of the blood void-
ed in the hematuriacalculofa, when it proceeds efpe-
cially fromthelddneys orureter; and many of the fame
appearances are obferved when the blood proceeds
only from the bladder when a ftone is lodged there ;
but the attending fymptoms will commonly point out
the different feat of the difeafe.

In one cafe, when a quantity of blood from the kid-
ney or ureter is coagulated in the bladder, and is there-
fore difficultly thrown out from this, the pain and un-
eafinefs on fuch an occafion may appear chiefly to be
in the bladder, though it contains no flone ; but the
antecedent fymptoms will commonly difcover'the na-
ture of the difeafe.

VOL. II. F MXXXVIII.

* In general, the blood is coagulated and grumous ; hence the
urine depofits a dark brown fubftance fomewhat refembling coffee-
grounds. As the grumous blood is fpecifically heavier than the u-
rine, it falls to the bottom of the bladder, and is consequently voided
in greater quantity in the beginning than towards the end of mak-
ing water, the urine that comes off firit being very deep coloured
and muddy, but becoming while it flows, gradually more tranfpa-
rent and pure, until at hit it is perfectly of a natural appearance.
The patient generally mentions this circumflance in defcribing his
complaints, with this addition, that he has in the beginning fome
difficulty of making water, but that this difficulty deereafes in pro-
portion as the urine becomes more tranfparent.

42 PRACTICE

MXXXVIII.

In any of the cafes of th'e hematuria calculofa, it
will hardly be necefTary to employ the remedies fuited
to an active hemorrhagy. It will be proper only to
employ the regimen fit for moderating hemorrhagy in
general, and particularly here to avoid every thing
or circumflance that might irritate the kidneys or ure-
ters. Of fucli cafes of irritation there is none more
frequent or more confiderable than the prefence of har-
dened fasces in the colon ; and thefe therefore are to
be frequently removed, by the frequent ufe of gentle
laxatives*.

MXXXIX.

The hematuria calculofaf may be properly eonii-
dered as a cafe of the hematuria violenta : and there-
fore I fubjoin to that the other inftances of hematuria
frum external violence ; fuch as that from external
contuiion on the region of the kidneyj, and that from

the

* Clyfters are preferable to purgatives in thefe cafes, becaufe
they are k-fs ilimu'ating ; and the emollient clyflers are preferable
to all others, for their only intention istofofion the hardened fasces.
The only purgatives to be ufed are thofe of the mildeft kind, as
manna, oil, caffia, &c. The intention of purgatives, in thefe cafes,
is only to remove the hardened fasces; and this intention can often
be fufficiently anfwered by a proper choice of food, as broths, ef-
pecially thofe made of barley and young animal flefh ; barley-gruel,
with prunes boiled in it ; ftewed endive, lettuce, and other olerace-
ous difhes.

•J- Tiie hematuria calculofa being fymptomatic, can only be cur-
ed by removing the caufe ; it may however, be greatly relieved by
demulcents, as linefeed-tea, decoclions of mardimallows, mucilage
of gum Arabic, thick barley-water, &c.

j The hematuria proceeding from a contufion of the region of
the kidneys, requires general and topical bleeding, with purge?, and
an attention to the antiphlogiilic regimen. Some practitioners re-
co'.n:nend the warm balfams in thefe cafes; but on account of their
heating quality, their ufe is fomewhat doubtful. Nitre is not always
admifiible, on account of its irritating the kidneys : but it is a pow-
erful antiphlogiilic ; and, if it is ufed in thefe cafes, it rr.uft be well

O F P H Y S I C. 43

the violent or long continued exercife of the mufcles
incumbent on the kidneys. An inftance of the latter
caufe occurs efpecially in riding*.

MXL.

Itmayalfobe confidered as a cafe of the hematuria
violenta, when the difeafe occurs in confequence of
the taking in of certain acrid fubftances, which pafs
again efpecially by the urinary paffages ; and, by in-
flaming and f welling the neck of the bladder, bring on
a rupture of the over-did ended blood-veflels, and give
occafion to a bloody urine. The mod noted inftance
of this is in the effedl of cantharides in a certain quan-
tity, any way introduced into the body. And poffi-
bly forne other acrids may have the fame effecl-j-.

MXLI.

Befide thefe moft frequent inftances of hematuria,
which cannot be coniidered asidiopathic hemorrhagies,

F 2 v there

diluted : the mucilaginous drinks are abfolutely necefTary, and ought
to be ufed plentiful!}^

* The only method of treating this kind of hematuria is by reft.
A perfon fubjeft to it ought never to ride.

f This fpecies oWlematuria is cured by evacuating the acrid fub-
ftance, and by the ufe of the mucilaginous drinks before mentioned.
The acrid fubftance may be evacuated by antiphlo^ilac purges, or
by the milder diuretics, as nitre, deco£lion of pariley roots, cream
of tartar whey, &c. The a&ion of cantharides on the urinary paf-
fages is not well explained. We can fcarcdy believe th'it any part
of the cantharides is abforbed from the bliftering plaiiter ; yet its
efFe&s are the fame with thofe produced by taking the canthai ides
niter/naljy. The ftrangury, and its concomitant fymptoms, may be
relieved by large and plentiful dilution, and a free ufe of the rr.ucilagi-
rous drinks. Camphor has been thought to have fome fpecific qua-
lity in preventing and curing the ftrangury produced by bliilers, and
experience warrants the conclufion : efpecially if the camphor isjoin-
ed with opium as in the following formula :
&. Camphor, gr. vi.

Spir. vini gutt. x.

Opii puri gr. i.

Conierv. rofar, 5:.

M. f. bolus.

44 PRACTICE

there are fome other inftances of hcmaturia mentioned
by authors, that are ftill however manifeflly fymptoma-
tic; fuch asadifchargeofblcod from the uri nary p adag-
es, in co^fequenceof a fuppreifion of either themcnfirual
or herfiorrhoidal flux. Thefe may be coniidered as
analogous to the hematemelis produced by the like
caufes ; and thefeveral reflections made above on that
fubject, will, I think, apply here, and particularly the
conclulions formed in MXXIV. Inftances, however,
of either of thefe cafes, and efpecially of the firil, have
been extremely rare.

MXLII.

Of fuch fymptomatic hcmaturia there is however
pne inflance deferving notice ; and that is, when a
fuppreffion of the hemorrhoidal flux, either by a com-
munication of veiFels, or merely by thevicinity of parts,
occafions a determination of the blood into the vef-
fels of the neck of the bladder, which in confequence
of a rixis or anaftomofis, pour out blood to be voided
either with or without the urine. This cafe is what
lias been named the Hemorrhoides Veficae ; and with
fome propriety, when it is manifeflly an evacuation
vicarious of what had before been ufyally made from
the re&urn. With refpect to the management of the
hemorrhoides veficae, I would apply the whole of the
d '£tris>es that 1 have delivered above, with refpcct to
the cure of the proper hemorrhoidal affection*.
MX LIU.

There remains ftill to be mentioned one other in-
rtance of fymptomatic hematuria, which is that which,
happens in the cafe of confluent and putrid fma!l-poxs
us well as in feveral other inftances of putrid dileaf-
cs. The blood, in fuch cafes, may be pretumed to
come from the kidneys; and 1 apprehend that it comes
from thence in confequence of that fluidity which, is
always produced in the blood approaching to a putrid

flate

* Articles 947, et fequent.

OF P H Y S I Q. 43

Such hematuria, therefore, is not to be confi-
de td as a fymptom of any affection of the kidneys,
but merely as a mark of the pturefcent ftate of the
fclood.

MXLIV.

In certain difeafes the urine is difcharged of fuch a
deep red c< lour, as give a fufpicion of its being ting*
ed by bloud preientin it; and this has given occalion
to Sauvages, a*nongtt the other fpecies of hematuria, to
mark the hematuria fpuria, and the hematuria lateri-
tia; both of which, however, he fuppofes to be with-
out any blood prefent in the urine. In many cafes it
is of importance, in aicertaining the nature of a dif-
ea£ •, to determine whether the red colour of urine be
from blood prefent in it, or from a certain flate of the
falts and oils which arc always in greater or leffer pro-
portion ccnilituent parts of the urine ; and the quef-
tion may be commonly determined by the following
^onfiderations.

It has been obferved above, that when any confi-
derable quantity of blood is voided with the urine,
there is always a portion of it depofitcd at the bot-
tom of the veffel containing the voided blood and u-
rine ; and in fuch a cafe there will be no doubt in at-
tributing the colour of the urine floating above, to
ibme part of the blood diffufed in it. The quefh'on,
therefore, with refpecl; to the prefence of blood in the
urine, can only occur when no fuch dcpofition as I
have mentioned appears ; and when the blood that
may be fuppofed to be prefent is diflblved or diffufed,
and therefore entirely .fufpended in the urine. In this
cafe the prefence of the blood may be commonly
known, ill, By the colour which blood gives, differ-
ent from any urine without blood that I have ever
feen ; and I think a little experience will enable mbfl
perfons to make this diflinclion. 2diy, By this, that
the prefence of blood always dirnmifhes the tranfpa-

rencv

46 PRACTICE

rency of ths urine with which it is mixed : and it is
very feldom that urine, though very high-coloured,
lofes its tranfparency ; at leaft this hardly ever ap-
pears, if the urine is examined when recently voided.
3dly, When urine has blood mixed with it, it tinges
a piece of linen dipt into it with a red colour, which
the higheft-coloured urine without blood never does.
4thly, High-coloured urine without blood, upon cool-
ing, and remaining at reft in a veflel, almoft always
depofites a lateritious fediment ; and if upon any oc-
cafion bloody urine fhould depofite a fediment that
may be of a. portion of the blood formerly difFufed in
it, the difference, however, may be difcerned by this,
that the fediment depofited by urine without blood,
upon the urine's being again heated, will be entirely
re-diifoived, which will not happen to any fediment
from blood. Laftly, we know no flate of urine with-
out blood, which mews any portion of it coagulable
by a heat equal to that of boiling-water ; but blood
difFufed in urine is Mill coagulable by fuch a heat : and
by this teft, therefore, the prefence of blood in urine
may be commonly afcertaincd.

BOOK V.

OF PROFLUVIA, OR FLUXES, WITH

PYREXIA.
/

MXLV.

FORMER riofologifts have eftabliflied a clafs of
difeafes under the title of Fluxes, or Profluvia ;
but as in this clafs they have brought together a great
number of difeafes, which have nothing in common^

excepting

O F P H Y S I C, 47

excepting the fmgle circumftaace of an increafed dif-
charge of fluids, and which alfo are, in other refpecls,
very different from one another; I have avoided fo
improper an arrangement, and have diftributed moil
of the difeafes comprehended in fuch a clafs J?y the
nofoiogifts, into places move natural and proper for
them*. I have, indeed, flill employed here the gene-
ral title ; but I confine it to fuch fluxes only as arc
constantly attended with pyrexia, and which therefore
neceflarily belong to the clafs of difeafes of which I
am now treating.

Of the fluxes which maybe confidered as being ve-
ry conftantly febrile difeafes, there are only two, the
catarrh and dyfentery ; and of thefe therefore 1 now
proceed to treat.

CHAP. I.
OF THE CATARRH.

MXLVL

catarrh is an increafed excretion of mucus
_ from the mucous membrane of the nofe, fauces,
and bronchiae, attended with pyrexia.

Practical writers and nofologiils have diftinguiilied
the difeafe by different appellations, according as ic
happens to affect thofe different parts of the mucous
membrane, the one part more or lefs than the or her :
But I am of opinion, that the difeafe, although affecl-

ing

* Sauvages enumerates no lefs than thirty-fix genera of fluxes,
each of which is fubdivided into numerous fpecies. VogeLhas for-
ty-five genera, under the title of profluviu, mod of which are ex-
tremely different from each other in their eflential qnalitiec.

48 PRACTICE

ing different parts, is always of the fame nature, and
proceeds from the fame caufe. Very coirrnonly, in-
deed, thofe different parts are affecled at the fame
time ;• and therefore there can be little room for the
difiin&ion mentioned.

The difeafe has been frequently treated of under the
title of Tuflis, or Cough ; and a cough, indeed, always
attends the chief form of catarrh, that is, the increaf-
ed excretion from the bronchia : but a cough, is fo
often a fymptom of many other afFedtions, which are
very different from one another, that it is improperly
employed as a generic title.

MXLVII.

The remote caufe of catarrh is mod commonly cold
applied to the body. This application of cold pro-
ducing catarrh, can in many cafes be diftinctly ob-
ferved ; and I would believe it always to be fo, were
men acquainted with, and attended to, the circum-
ilances which determine cold to a6t upon the body.
See xciv — xcvi.

From the fame paragraphs we may learn what in
fome perfons gives a predifpofition to catarrh.
MX L VIII.

The difeafe, of which I am now to treat, generally
begins with fome difficulty of breathing through the
nofe, and with a fenfe of fome fullnefs (lopping up
that paflage. This is alfo often attended with fome
dull pain and a fenfe of weight in the forehead, as well
as fome ftiffhefs in the motion of the eyes. Thete feel-
ings, fometimes at their very firft beginning, and al-
ways foon after, are attended with the diftillation from
the nofe ; and fometimes from the eyes, of a thin fluid,
which is often found to be fomewhat acrid, both
by its tafte, and by its fretting, the parts over which
it paifes.

MXLIX.

Thefe fymptoms confHtuce the cory-za and gnivccU

of

O F P H Y S I C. 49

of medical authors, and are commonly attended with
a fenfe of laflitude over the whole body. Sometimes
cold fhiverings are felt, at lead the body is more fenfi-
ble than ufual to the coldnefs of the air ; and with all
this the pulfe becomes, efpecially in the evenings,,
more frequent than ordinary.

ML.

' Thefe fymptoms feldom continue long before they
are accompanied with fome hoarfenefs, and a fenfe of
roughnefs and forenefs in the trachea, and with fome
difficulty of breathing, attributed to a fenfe of (trait-
nefs of the cheft, and attended with a cough, which
feems to arife from fome irritation felt at the glottis.
The cough is generally at firfl dry, cccafioning pains
about the cheft, and more efpecialiy in the bieaih
Sometimes, together with thefe fyn ptoms, pains re-
fembling thofe of the rheumatifm arc felt in feveral
parts of the body, particularly about the neck and
Jiead. While thefe fymptoms take place, the appe-
tite is impaired, fome third arifes, and a general lafli-
tude is felt over all the body.

MLL

Thefe fymptoms (MXLVIII — ML.) mark the violence
and height of the difeafe ; which, however, does not
commonly continue long. By degrees the. cough be-
comes attended with a copious excretion of mucus ;
which is at firft thin, but gradually becoming thicker,
is brought up with lefs frequent and lefs laborious
Coughing. The hoarfenefs and forenefs of the tra-
chea, Hkewife going off, the febrile fymptoms abating,
the cough becoming lefs frequent, and with lefs ex-
pectoration, the difeafe foon after ceafes altogether.

MLII.

Such is generally the courfe of this difeafe, which is
commonly neither tedious nor dangerous; but, upon
fome occafions, it is in both refpects otherwise. A
perfon affected with catarrh feems to be more than u-

VOL. II. G fually

50 PRACTICE

fually liable to be affe&ed by cold air ; and in that
condition, if expofed to cold, the difeafe, which feem-:
ed to be yielding, is often brought back with greater
violence than before : and is rendered not only more
tedious than otherwife it wotdd have been, but alfo
more dangerous by the fupervening of other difeafes.

MLIII.

Some degree of the cynanche tonlillaris often ac-
companies the catarrh ; and when the latter is aggra-
vated by a freili application of cold, the cynanche al-
fo becomes more violent and dangerous, in confe-
quence of the cough which is prefent at the iame
time.

JMLIV.

When a catarrh has been occafioned by a violent
caufe ; when it has been aggravated by improper ma-
nagement ; and efpecially when it has been render-
ed more violent by freili and repeated applications of
cold, it often pailcs into a pneumonic inflammation
attended with the utmofl danger.

MLV.

Unlefs, however, fuch accidents as thofe of MLII—
MLIV. happen, a catarrh, in fotind perfons not far
advanced in life, is, I think, always a flight difeafe,
and attended with little danger. But, in perfons of a
phthiiical difpofitton, a catarrh may readily produce
a hemoptyfis, or perhaps form tubercles in the lungs ;
and more certainly, in perfons who have tubercles al-
ready in the lungs, an accidental catarrh may occa-
fionthe.inflammation of thefe tubercles, and in confe-
quence produce a phthiiis pulmonalis.

MLVI.

In elderly perfons, a catarrh- fornetimes proves a
dangerous difeafe. Many perfons, as they advance
in lire, and efpecially after they arrive at old age,
have the natural mucus of the lungs poured out in
greater quantity, and confequently requiring a fre-
quent

OF PHYSIC. 51

quent expectoration. If therefore a catarrh happen
to fueh perfons, and increafe the afflux of fluids to
the lungs, with fome degree of inflammation, it may
produce the pcripneumonia notha, which in fuch caf-
es is very often fatal, See CCCLXXVI — CCCLXXXU.

MLVII.

The proximate caufe of catarrh feems to be an in-
creafed afflux of fluids to the mucous membrane of
the riofe, fauces, and bronchia^ along with fome de-
gree of inflammation affecling thefe parts . The lat-
ter circumftance is confirmed by this, that in the cafe
of catarrh, the blood drawn from a vein, commonly
exhibits the fame inflammatory crufl which appears in
the cafe of phlegmafiae.

MLVIII.

The application of cold wiieh occafions a catarrh,
probably operates by diminiming the perfpiration ufu-
ally made by the fkin, atid which is therefore deter-
mined to the mucous membrane of the parts above
mentioned. As a part of the weight which the body
daily loies by infenfible evacuation, is owing to an ex-
halation from the lungs, there -is probably a connec-
tion between this exhalation and the cutaneous per-
fpiration, fo that the one may be increafed in p&por-
tion as the other is diminifried : and therefore we
may underfland how the diminution of cutaneous per-
fpiration, in confequence of the application of cold,
may increafe the afflux of fluids to the lungs, and,
thereby produce a catarrh.

ML IX.

There are fome obfervations made by Dr. James.
Keil which may feem to render this matter doubtful ;
but there is a fallacy in his obfervations. The evident
effects of cold in producing coryza, leave the matter
in general without doubt; and there are feveral other
circumftances which (how a connexion between the
lungs and the furface of the body.

G 2 'MLX.

$z PRACTICE

MLX.

Whether, from the fuppreflion of perfpiration, a
catarrh be produced merely by an increafed afflux of
fluids, or whether the matter of perfpiration be at the
fame time determined to the mucous glands, and there
excite a particular irritation, maybe uncertain; but
the latter fuppofition is fufficiently probable.

MLXI.

Although, in the cafe of a common catarrh,
which is in many inftances fporadic, it may be doubt-
ful whether any morbific matter be applied to the mu-
cous glands ; it is, however, certain, that the fymp-
toms of a catarrh do frequently depend upon fuch a
matter being applied to thefe glands; as appears from
the cafe of the meafles, chin-cough, and efpecially
from the frequent occurrence of contagious and epide*
mical catarrh.

MLXII.

The mention of this laft leads me to obferve, that
there are two fpecies of catarrh, as I have marked in
my Synopiis of Nofology. One of thefe, as I fuppofe,
is produced by cold alone, as has been explained above ;
and the other feems manifellly to be produced by a
fpeciic contagion.

Of fuch contagious catarrhs*, I have pointed out in
the Synopfis many inftances occurring from the 14th
century down to the prefent day. In ail thefe in-
ftances the phenomena have been much the fame ;
and the difeafe has always been particularly remarka-
ble in this, that it has been the mod widely and ge-
nerally fpreading epidemic known. It has ieldom ap-
peared in any one country of Europe, without appear-
ing fucceflively in every other part of it ; and in fome
inftances, it has been even transferred to America, and

has

* Thefe epidemical catarrhs have been lately termed Influenzas.

O F P H Y S 1 C. 5.3

has been fpread over that continent, fo far as we have
had opportunities of being informed.
MLXIII.

The catarrh from contagion appears with nearly
the famefyniptoms asthofe mentioned MXLVIII. — ML.
It feems often to come on in confequence of the ap-
plication of cold. It comes on with more cold fhiver-
Ing than the catarrh ariling from cold alone, and foon-
cr mows febrile fymptoms, and thefc likewife in a
more confiderable degree. Accordingly, it more fpee-
dily runs its courfe, which is commonly iinimed in a
few da} s. It fometimes terminates by a fpontaneous
fweat ; and this, in fome perfons, produces a miliary
eruption. It is, however, the febrile ftate of this dif-
eafe efpecially, that is finiHied in a few days : for the
cough, and other catarrhal fysnptoms, do frequently
continue longer ; and often, when they appear to be
going off, they are Renewed by a.ny frefh application
©f cold.

MLXIV.

Confidering the number of perfons who arc affected
with catarrh, of either the one fpecies or the other,
and efcape from it quickly without any hurt, it may
be allowed to be a difeafe very free from danger; but
St is not always to be confidered as fuch ; for in fomc
perfons it is accompanied with pneumonic inflamma-
tion. In the phthiiically difpofed, it often accele-
rates the coming on of phthifis ; and in elderly per-
fons, it frequently proves fatal in the manner explain-
ed above, MLIV. and MLVI.

MLXV.

The cure of catarrh is nearly the fame, whether it
proceed from cold or contagion ; with this difference,
that in the latter cafe, remedies are commonly more
neceffary than in the former.

In the cafes of a moderate difeafe, it is commonly
Sufficient to avoid cold, and to abftain from animal

food

54 PRACTICE

food for fomedays* ; or perhaps to lie a-be-d, and by
taking frequently of fome mild and diluent drink, a
little warmed, to promote a very gentle fweat ; and
after thefe to take care to return very gradually only,
to the ufe of the free air.

MLXVI.

When the dMeafe is more violent, not only the anti-
phlogiftic regimen mufl be exactly obferved, but va-
rious remedies alfo become neceiTary.

To take off the phlogiftic diatheiis which always at-
tends this difeafe, blood-letting, in* a larger orfmaller
quantity, and repeated according as the fymptoms fhall
require, is th«ftproper remedy.

For reftoring the determination of the fluids to the
furfuce of the body§, and at the fame time for cxpe-
ding the fecretion of mucus in the lungs, which may
take off the inflammation of its membrane, vomiting
is the mod effectual means.

. For the latter purpofe, it has been fuppofed, that

fquills,

* Perhaps an abftinence from all food would accelerate the cure :
The mucilaginous drinks ought to be taken in considerable quanti-
ties, and they are fomewhat nutritive.

§ The means of producing a gentle and continued perspiration
have been mentioned in a former note. In catarrh, however, the
yfe of the warmer fudorifics leems more effectual. The elixir pare-
goricum, diluted with whey, efpecially whey made with the dulcified
ipirit of nitre, is of fmgular ufe ; but it ought not to be given if there
is a conCderable degree of phlogiftic diathefis. In this cafe a fpoon-
ful of the following folution may be t?iven every two or three hour?,
till a fweat breaks out :

§,. Tart. emet. gr. ii.

Aq. font. 5\'i.

Syr. Althaeie ?ii.

M.

It will be necefTary for the patient to chew cccafionally fome muci-
laginous demulcent, as Extract of Liquorice, Sec. or to take a tca-
(poonful of equal parts of oil and honey, in order to prevent the (harp
matter from irritating the fauces. The Elect, pectorale of the"

O F P H Y S I a 55

fquills, gum ammoniac*, the volatile alkali, and fome
other medicines, might be ufeful : but their efficacy
has never appeared to me to be coniiderable ; and, if
fquills have ever been very ufeful, it feems to have
been rather by their emetic, than by their expecto-
rant powers.

When the inflammatory afFe&ions of the lungs
feem to be considerable, it is proper, be fides blood-
letting, to apply bliilers on fome part of the thorax.

As a cough is often the moil troublefome circum-
fiance of this difeafe, fo demulcents may be employed
to alleviate it. See CCCLXXIII.

But afrer the inflammatory fymptoms have much a-
bated, if the^ough ihould ftill continue, opiates af-
ford the moil effectual means of relieving it; and in
the circumilances juft now mentioned, they may be
very fafely employed. Sec CCCLXXV.

After the inflammatory and febrile flates of this
difeafe are almoil entirely gone, the moil effe&ual
means of difcuffing all remains of the catarrhal af-
fe&ion, is by fome exercife of geflation diligently em-
ployed.

CHAP.

Edinburgh Pharmacopoeia not only relieves the tickling, but tends
to produce a falutary diaphorefis ; its dofe is the fize of a nutmeg
three or four times a-day.

* The ammoniac and fquiiJs may be joined together in the fol-
lowing form :

$,. Lac ammoniac, giv.
Syr. Scillit. £iii.
M.

This mixture mud be acknowledged to be fomewhat naufeou*,
biit it has confiderable efficacy. The dofe of it is two, or (if the
itomach can bear it) three table fpoor.fuls twice a-da

5« PRACTICE

CHAP. II.
OF THE DYSENTERY.

MLXVII.

THE dyfentery is a difeafein which the patient has
frequent (tools accompanied with much griping,
and followed by a tenefmus. The ftools, ihough fre-
quent, are generally in fmall quantity ; and. the mat-
ter voided is chiefly mucus, ibmetimes mixed with
blood. At the fame time the natural feces feldom ap-
pear, and, when they do, it is generally in a compact
and hardened form.

MLXVIII.

This difeafe occurs efpecially infummer and autumn?
at the fame time with autumnal intermittent and
remittent fevers ; and with thefe it is fometimes com-
bined or complicated*.

MLXIX.

The difeafe comes on fotnetimes with cold fhiver-
ings, and other fymptoms or pyrexia; but more com-
monly the fymptoms of the topical affection appear
firft. The belly is coftive. with an unufual flatulence
in the bowels. Sometimes, though more rarely, fome
degree of diarrhoea is the firft appearance. In mod
cafes the difeafe begins with griping, and a frequent
inclination to go to^ftool. In indulging this, little is
voided ; but fome tenefmus attends it. By degrees,
the ftools becomes more frequent, the griping more
fevere, and the tenefmus more confiderable. Along
with thefe fymptoms there is a lofs of appetite ; and
frequently ficlcnefs, naufea, and vomiting, alfo affect-
ing the patient. At the fame time there is always
more or lefs of pyrexia prefent, which is fometimes of

the

* It appears more efpecially In armies encamped In low fwampy
§rouiids»»rid, without proper management., is highly deftru&ive.

O F P H Y S I C. 57

ihe remittent kind, and obferves a tertian period. — .
Sometimes the fever is manifeftly imflammatory, and
very often of a putrid kind. Thefe febrile itates con-
tinue to accompany the difeafe dining its whole
courfe, efpeciully when it terminates foon in a fatal
manner. In other cafes, the febrile ftate almofl en-
tirely difappears, while the proper dyfenteric fymp-
toms remain for a long time after.

MLXX.

In the courfe of the difeafe, whether of fhorter or*
longer duration, the matter voided by ftool is very va-
rious. Sometimes it is merely a mucous matter,
without any blood exhibiting that difeafe which J)r.
Roderer has named the morbus mucofus, and others
the dyfenteria alba. For the moft part, however, the
mucus discharged is more or lefs mixed with blood.
This fome times appears only in ftreaks amongft the
mucus ; but at other times is more copious, tinging
the whole of the matter discharged; and upon fome
occaiions a pure arid unmixed blood is voided in con-
iiderable quantity. In other refpeds, the matter
voided is varioufly changed in colour and conlillence,
and is commonly of a ftrong and unufually fetid odour^
It is probable, that fometimes a genuine pus is voided;
and frequently a putrid fanies, proceeding from gan-
grenous parts. There are very often mixed with the
liquid matter fome films of a membranous appearance,
and frequently fome finall maffes of a feemingly feba-
ceous mutter.

MLXXI.

While the flools confuting of thefe various matters
are in many inftances, exceedingly frequent, it is fe1-
dom that natural faeces appear in them ; and when
they do appear, it is, as I have mentioned, in 'he
form of fcybala, that is, in fomewhat hardened, ft- pa-
rate balls. When thefe are voided, whether by the
efforts of nature, or as Solicited by art, they proem e

H a lemif-

58 PRACTICE

a reniilfion of all the fymptoms, and more efpeci-
ally of the frequent {tools, griping, and tcnefnius.

MLXXII.

Accompanied with thefe circumftances, the difeafe
proceeds for a longer or a fhorter time. When the
pyrexia attending it is of a violent inflammatory kind,
and more efpecially when it is of a very putrid nature,
the difeafe often terminates fatally in a very few days,
with all the marks of a fupervening gangrene. When
the febrile ilate is more moderate, or difappears alto-
gether, the difeafe is often protracted for weeks, and
even for months; but even then, after a various dura-
tion, it often terminates fatally, and generally in con-
iequence of a retuin and conikierable aggravation of
the inflammatory and putrid dates. In fome cafes,
the difeafe ceafes fpoiitaneouily ; the frequency of
(tools, the griping, and tenefmus, gradually diminifh-
es, while natural (tools return. In other cafes, the
difeafe, with moderate fymptoms, continues long, and
ends in a diarrhoea, fometimes accompanied with li-
cnteric fymptoms.

MLXXIII.

The remote caufes of this difeafe have been vari-
oully judged of. It generally aiifcs in fummer or au-
tumn, after confiderabie heats have prevailed for fome
time, and efpecially after very warm, and at the fame
time, very dry dates of the weather ; and the difeafe
is more frequent in warm, than in cooler climates. —
It happens, therefore, in the fame circumltances and
feafons which coniiderably affecl the (tate of the bile
in the human body ; but us the cholera is often with-
out any dyicnteric (ymptoms, and copious diicharges
of bile have been found to relieve the iymptorns of dy-
lt-ntery, it is difficult to determine what connection
the difeafe has with the (tate of the bile.

MLXX1V.

It has been obferved, that the effluvia from very pu-
trid

O F P H. Y S I C. 59

tiid animal fubftances, readily affecl the alimentary
canal ; and upon fome occafions they certainly pro-
duce a diarrhoea ; but, whether they ever produce a
genuine dyfentery, I have not been able to learn with
certainty.

MLXXV.

The dyfcntery does often manifeflly arife from the
application of cold, but the difcafe is .always contagi-
ous; and by the propagation of fuch contagion, inde-
pendent of cold, or other exciting caufes, it becomes
epidemic in camps and other places. It is, therefore,
to. be doubted, if the application of cold does ever
produce the difeafe, unlcfs where the fpecific contagi-
on has been prcviouily received into the body : And
upon the whole, it is probable, that a fpeciiic contagi-
on is to be confidered as always the remote caufe of
this difeafe.

MLXXVI.

Whether this contagion, like many others, be of a
permanent nature, and only (hows its effects in certain
circumftances which render it active, or if it be occa-
lionally produced, I cannot determine. Neither, if
the latter fuppofkion be received, can I fay by what
means it may be generated. As little do we know any
thing of its nature, confidered in hfelf 9 or at moil this
only, that in common with many other contagions, it
appears to be commonly of a putrid nature, and capa-
ble of inducing a putrefcent tendency in the human
body. This, however, does not at all explain its pecu-
liar power in inducing thofe fymptoms which proper-
ly and effentially coniiitute the difeafe of dyfentery.
(MLXVII.)

MLXXV1I.

Of thefe fymptoms the proximate caufe is ft ill ob~
fctire. The common opinion has been, that the dif-
cafe depends upon a-n acrid matter received into, or
generated in, the inteflines themfelvcs exciting their

H 2 perif-

6® . PRACTICE

periftaltic motion, and thereby producing the frequent
ftools which occur in this difeate. But this fuppbii-
tion cannot be admitted : for, in all the inftances
known of acrid fubftances applied to the inteftines
and producing frequent ftools, they at the fame time
produce copious ftools, as might be expected from
acrid fubftances applied to any length of the inteftines.
This, however, is not the cafe in dyfentery ; in which
the ftools, however frequent, are generally in very
fmall quantity, and fuch as maybe fuppofed to pro-
ceed from the lower parts of the rectum only. With
refpecl to the fuperior portions of the inteftines, and
particularly thofe of the colon, it is probable they are
under a preternatural and coniiderable degree of con-
ftriclion : For as I have obfcrved above, the natural
fseces are feldom voided ; and when they are, it is in
n, form which gives reafon to fuppofe, they have been
long retained in the cells of the colon, and confequent-
ly that the colon had been affected with a preternatu-
ral conftriclion. This is confirmed by aimed all the
directions which have been made of the bodies of dy-
fenre.'ic patients, in which, when gangrene had not
extirely deftroyed the texture and form of the pans,
considerable portions of the great guts have been
found affected with a very considerable conftriclion.

MLXXVIII.

I apprehend, therefore, that the proximate caufe of
dyfentery, or at leaft the chief part of the proximate
cauie, confifts in a preternatural conftriction of theco-
Ion, occafioning at the fame time thofe fpafmodic ef-
forts which are felt in fevere gripings ; and which
efforts, propagated downwards to the rectum, occaiion
there the frequent mucous ftools and tenefmus,. —
But, whether this explanation Ihall be admitted or
not, it will ftill remain certain, that hardened fasces re-
tained in the colon are the caufe of the giiping, fre-
quent ftools and tenefmus :for the evacuation of thefe

OF PHYSIC. 61

Faeces, whether by nature or by art, gives relief from
the fymptoms mentioned; and it will be more fully
and ufefully confirmed by this, that the moil immedi-
ate and fuccefsful cure of dyfentery, is obtained by
an early and conilant attention to the preventing the
conilriction, and the frequent ftagnation of faeces in
the colon.

MLXXIX.

In this manner I have endeavoured to afcertain the
proximate caufe of dyfentery, and therefore to point
out aifo the principal part of the cure, which from
want of the proper view of the nature of the difeafe,
feems to have been in feveral refpects fluctuating and
undetermined among practitioners.

; MLXXX.

The moft eminent of our late practitioners, and of
greatefl experience in this difeafe, feem to be of opi-
nion, that the difeafe is to be cured moil effectually
by purging affiduoufly employed. The means may
be various ; but the moil gentle laxatives are ufually
fufficient, and as they mud be frequently repeated,
the moil gentle ate the moil fafe ; the more efpecially
as an inflammatory ilate fo frequently accompanies
the difeafe. Whatever laxatives produce an evacua-
tion of natural fasces, and a confequent remiffion of
the fymptcms, will be furncient to effectuate the cure.
But if gentle laxatives mall not produce the evacua-
tion now mentioned, feme more powerful medicines
muit be employed* : and I have found nothing more

proper

* I flrall fubjoin fome formulas fuitable for procuring a paflagf
in the dyfentery.

£>. Infuf. fenn, gii.
Mannas opt, 51.
M. f. hautt.
&. Maiinae gi.

Sal. Glauber gfs.

Solve in aq. bullient. giii. et adde

Tindl, Cardamomi 31.

62 PRACTICE

proper or convenient than tartar .emetic, given in
Imall dofes, and at fuch intervals as may determine
their operation to be chiefly by itool. Rhubarb, fo
frequently employed, is in feveral refpccls amongft
the moil improper purgatives.

MLXXXL

Vomiting has been held a principal remedy in this
difeafe ; and may be ufefully employed in the begin-
ning of it, with a view to both the Hate of the flomach
and of the fever : but it is not neceflary to repeat it
often ; and unlefs the emetics employed operate alfo
by ftool, they are of little fervice. Ipecacuanha feems
to poiTefs no fpecific power : and it proves only ufeful
when fo managed as to operate chiefly by flool.
MLXXXII.

For relieving the conftriction of the colon, and e-
vacuating the retained fasces**, glyfters may fometimes
be ufeful : but they arc feldom fo effectual as laxatives
given by the mouth ; and acrid glyfters, if they be not
effectual in evacuating the colon, may prove hurtful
by ftimulating the rectum too much.
MLXXXIU.

The frequent and fevere griping attending this dif-
eafe, leads almoft neceffarily to the ufe of opiates, and
they are very effectual for the purpofe of relieving from
the gripes; but by occafioning an interruption of the ac-
tion

Where ftronger purgatives arc requifite,
£>. Refin. Jalap, gr. x. vel. xv.

Tere in mortario marmoreo, cum
Armygdal. dale* decort. No. iii.
Sach. alb. '31.
Dein adde

Aq, cinnamom. fimpl. ^ifs.
M.

* Clyfters in thefe cafes ought to be made very large, and they
ought alfo to be very mild ; as a pint and an half, or even two pints,
of thin lintfeed-tea, or decodion ofmarflvmallows, without any o-
ther addition.

OF PHYSIC. <%

tion of the fmall guts, they favour the con Uriel ion of
the colon, and^thereby fometimes aggravate the dif-
eafe.: and if at the fame time the ufe of them fuperfede
in any meufure the employing of purgatives, it com-
monly does much mifchief ; I believe it indeed to be
only the negledl of purging, that renders the ufe of
opiates very neceflary*.

MLXXXIV.

When the gripes are both frequent and fevere, they
may fometimes be relieved by the employment of a
femicupium, or by a fomentation of the abdomen,
continued forfome time. In the fame cafe, the pains
may be relieved, and, as I think, the conftriction of
the colon may be taken off, by bliiters applied to the
lower bellyj-.

MLXXXV.

At the beginning of this difeafe, when the fever is
any way considerable, blood-letting, in patients of to-
lerable vigour, may be proper and neceflary ; 'and,
when the pulfe is full and hard, with other fymptoms
of an inflammatory difpofition, blood-letting ought
to be repeated. But, as the fever attending dyfente-
ry is often of a putrid kind> or does, in the courfe of

the

* The griping is much relieved, and fometimes prevented, by
drinking plentifully of any mucilaginous warm Jiquois during the
operation of the purges ; as barley-water, with bruited prunes boil-
ed in it*.

f Bliilers applied to the abdomen, befides being cv;c' fn\v!y trou-
blcfome, muft necefiarily be extremely painful. Practitioners have
probably been deceived in thinking that blifters have relieved griping
in the dyfentery, for they are feldom employed alone ; and the effects
of purges and diluents have perhaps been miftaken for the effects of
a blifter that might have happened to have been applied at the time
when thefe other remedies were ultd. Too itridt an attmtion to t)ic
falfe axiom, poll hoc ergo propter hoc, has been the fourcc of nu-
merous errors in the practice of phyfic, and has rai'fcd the reputa-
tion of the phyfichui and his remedies, when the mciit was only
due to nature.

64 PRACTICE

the difeafe, become foon of that nature, blood-letting
muft be employed with great caution.
MLXXXVI.

From the account now given of the nature of this
difeafe, it will be fufficiently obvious, that the ufe of
aftringents in the beginning of it mull be abfolutely
pernicious.

MLXXXVII.

Whether an acrid matter be the original caufe of
this difeafe, may be uncertain : but from the indigef-
tion and the ftagnation of fluids in the ilomach which
attend the difeafe, it maybe prefumcd, that fome acrid
matters are conftantly prefentin theitomach and intef-
tines, and therefore that demulcents may be always
ufefully employed. At the fame time, from this con-
lideration that mild oily matters thrown into the in-
teftines into confiderable quantity always prove laxa-
tive, I am of opinion that the oleaginous demulcents
are the mod uieful*.

MLXXXVIIL

* Some forms of thcfc demulcents are given in the Pharmacopoeia*
The following may be added for the fake of variety, as the patient
frequently loaths Linclufes.
%,. Mann, opt.

Ol. Amygdal. recent, a a |i.
Syr. e Cort. aur'ant. %&•
M.

&. Syr. althaese.
Ol. Amygdal.
Elect, lenitiv. a a ?i.
M.

^. Confcrv. cynolbat. gi.
Syr. rofar.

Ol. Amygdal a a §ii.
M.

Two tea-fpoonfuls of any of the above tinctures may be gi?cri
every hour, or every other hour, drinking, at the fame time, bar*
ley-water with bruvfed prunes boiled in it.

The cure of a dyientery is briefly comprehended in keeping the
belly open, and ufmg mucilaginous diluents and lubricants.

O F P H Y S I C. 65

ML XXX VIII.

As this difeafe is fo often of an Inflammatory or of
a putrid nature, it is evident that the diet employed in
it fhculd be vegetable and acefcent. Milk in its en-
tire Hate is of doubtful quality ia many cafes; but
ibrne portion of the cream is often allowable, and
whey is. always proper.

In the firil flages of the difeafe, the f \veet and fuba-
cid fi'uits are allowable, and even proper. It is in
the more advanced flages only that any morbid acidi-
ty feems to prevail in the fcomach, and to. require.
fome referve in the ufe of accfcents. At the beniii-

O

ning of the difeafe, ahfor bents feem to be fuperfluous ;
•and by their aftringent and feptic powers they may be
hurtful.

MLXXXIX.

When this difeafe is complicated with an intermit-
tent fever, and is protracted from that circumuance
chiefly, it is to be treated as an intermittent, by ad-
miniilering the Peruvian bark, which, however, in
the earlier periods of the difeafe, is hardly to be ad-
mitted.

i

PART II.

O F

N.E u R o s E s,

O R

NERVOUS DISEASES.

MXC.

N a certain view, almofl the \vljole of the difeafes

of the human body might be called NERVOUS :

VOL. II. I but

uo

PRACTICE

but there would be no ufe for fuch a general appelk-
tion ; and, on the other hand, it feems improper to
limit the term, in the loofe inaccurate manner in
which it has been hitherto applied, to hyfteric or hy-
pochondiical diforders, which are themieives hardly
to be defined with fuiiicient precifion.

MXCI.

In this place I' propofe to comprehend, under the
title of NEUROSES, nllthofe preternatural afL6tions of
fenfe or motion which are without pyrexia, as a part
of the primary dife;fe; and all thole which do not
depend upon a topical affection of the organs, but up-
on a more general affection of the nervous fyftern,
and of thole powers of the iyftem upon which fenfe
and motion more efpecially depend.

ivixcu.

Of fuch difeafes I have eftablifhed a clafs, under the
title of NEUROSES or NERVOUS DISEASES. Thefe I
again diilinguifh, as they coniiit, either in the inter-
ruption and debility of the powers of fenfe and moti-
on, or in the irregularity with which thefe powers are
exercifed ; and have accordingly arranged-them under
the four orders of Gomata, Adynamias^ Spafmi, and Ve-
j'anicz, to be defined as we proceed to treat of them
more particularly.

B O O K

O F P H Y S I C. 67

BOOK I.
OF C O M A T A ;

OR, OF THE

LOSS OF VOLUNTARY MOTION.

MXCIII.

UNDER this title are comprehended thofe affec-
tions which have been commonly called the
Soporofe difeafes ;'but they are moil properly cliftin-
guiflied by their confiding in fome interruption or fup-
preffion of the powers of fenfe and voluntary motion,
or of what are called the animal functions. Thefe
are indeed ufually fufpended in the time of natural
fleep : but of ail the difeafes to be comprehended un-
der our title, fleep, or even the appearance of it, is
not conftantly a fymptom. Of iuch difeafes I can
mark and properly explain two genera only, which
co'me under the titles of Apoplexy and Palfy.

„«...<..< .<.<••<•<••<••<-<••<••<*£>••>••>•• >••>••>••>••>••> >•>••>••
C I! A P. I.

OF APOPLEXY.

MXCIV.

A POPLEXY is that difeafe in which the whole of
JL\. the external and interaalfenfes, and the whole
of the voluntary motions, are in fome degree abolifh-
cd ; while refpiration and the action of the heart con-

I 2 tinue

68 PRACTICE

tlnue to b£ performed*. By its being an affeftion of
the "jsloole of the powers of fenfe and of voluntary
motion^ we diftinguifli it from Palfy ; and by its be-
ing with the continuance of refpi ration ajid the ac-
tion of the heart, it is diftinguiQied from Syncips. I
have further added to the ordinary definition of apo-
plexy, that the abolition of the powers of fenfe and
motion is'ui fome degree only ; meaning by this to im-
ply, that, under the title of Apoplexy, are here com-
prehended thofe difeafes which, as differing from it in
degree only, cannot, with a view either to pathology
or practice, be properly diftinguimed from it : Such
are the difeafes fometimes treated of under the names
cf Car us 9 Catapbaray Ccmt, and Lethargus.

MXCV.

Apoplexy, in all its different degrees, mod common-
ly atfecls perfons advanced in life, and efpecially thofe
above fix'.y years of age. It mod ufually affects perfons
of large heads and fliort necksf , perfons of a corpulent
habir, perfons who hive palled an indolent life and ufed
a full diet, and efpecially thofe who have indulged in
frequent intoxication. Men who have long laboured
und-^r a frequent and copious difcharge of blood from

the

* " The appearance of a profound and continual fleep," is by
Boerhaave judicioufly added to the definition of Apoplexy.

To diflinguifh between a profound deep and apoplexy, which very
much referable each other, is, however, extremely eafy. A man in
a profound deep may in general be roufed by the application of ftrong
flimulants to the organ which produce no effcft on an apo-

plectic patient,

T ) diflitiguifii between apoplexy and a fit of drnnkenntfs is not fo
eafy ; for drunken people are fornetimes incapable of being roufed
by any IHmu'ants, remaining totally infenfiblc and motionkfs. The
fur.i.-is of the liquor with which they have been intoxicated may fome-
times be difcovered by fmelling : a drunken lit may alfo be known by
tlie palenefsof the drunken man's face, and by his manner of living.

f Different authors, one cf whom is Boerhaave, have fppofed
that a vertebra is wanting/the neck confiiling only of fix iuitcad of
ieven vertebrae.

OF PHYSIC. 69

the hemorrhoidal vefTels, upon either the fuppreffion
or fpontaneous ceafing of that difcharge, are particu-
larly liable to be affected with apoplexy.
MXCVI.

This difeafe frequently comes on very fuddenly :
but in many cafes it is preceded by various fymptoms,
fuch as frequent fits of giddinefs, frequent headachs, a
hemorrhagy from the nofe, fome tranfitory interrup-
tions of feeing and headng, fome falfe vifion and hear-
ing, fome tranfitory degree of nurnbnefs or lofs of
motion in the extremities, fome faltering of the
tongue in fpeaking, a lofs of memory, a frequent drow-
fmefs, and frequent fits of incubus*
MXCVIL

An attention to thefe fymptoms, and to the predif-
ponent circumftances, (MXCV.) will often enable us to
forefee the more violent attacks of this difeafe.
MXCVIII.

When the difeafe comeson fuddenly. to aconfiderable
degree, it has been frequently obfervecl to have been
immediately induced by violent exercife ; by a full
and long continued infpiration ; by a fie of anger ; by
much external heat, efpecially that- arifing from a
crowded aflembly of people ; by warm bathing ; by
intoxication ; by long (looping with the head down ;
and a tight ligature about the neck. The difeafe has
been remarked to make its attacks mofl frequently in
the fpring feafon, and efpecially when the vernal heat
fuddenly iucceeds to the winter cold.

MXCIX.

The fymptoms denoting the prefence of this dif-'
cafe will be fufficiently known from the definition giv-
en, MXCIV. Although the whole of the body is af-
fected with the lofs of fenfe and motion, it fometimes
takes place more upon one fide of the body than the
other; and, in that cafe, the fide lead affected with
palfy is fcmetimcs affected with convullions. In this

dif*

7o PRACTICE

difeafe there is often a ftertorous breathing; and this
has been faid to be a mark of the moil violent fiate of
the difeafe ; but it is not always prefent even in the
moil complete form or mod violent degree of the dif-
eafe,

MC.

The proximate caufe of this difeafe may be, in ge-
neral, whatever interrupts the motion of the nervous
power from the brain of the mufcles from voluntary
motion ; or, in fo far as fenfe is affected, whatever
interrupts the motion of the nervous power from the
isntient extremities of the nerves to the brain.

MCI.

Such an interruption of the motions cf the nervous
power may be occafioned, either by him ctmprejfion of
the origin of the nerves, or by fome thing dejtroying the
mobility of the nervous power. Both thefe cauies we
mufl treat of more particularly ; and, firft, of that of
Gornpreliion, feemingly'the moft frequent occaiion of
apoplexy, and perhvips the oecaiiun of ail thole apo-
plexies ariiing from internal caufes.

MCII.

The lofs of fenfe and motion in particular parts of
the body, may be occafioned by a comprelTi -.n, either
of the origin of certain nerves only, or of the fame
nerves in fume part of their courfe from the brain 10
the organs of ienfa and motion. Such cafes of par-
tial compreiRon will be more properly considered
hereafter ; and the affection I am now to treat cf be-
ing general, it mufl depend upon a very general com-
preilion of fhe origin of the nerves, or medullary por-
tion of the brain ; and therefore, this more general
compreffion only is to be coniidered here.

MCI1L

This compreffion cf the origin of the nerves or me*
dullary portion of the brain, may be produced in dif-
ferent ways 5 11 o,

i. By

O F P H Y S I fi. 71

1. By external violence fracturing and prefling in a
pan of the cranium.

2. By tumours, foractimes fofr, fometimes bony,
formed in different parts of the brain, or in its mern-
1 rants, and becoming of fuch a bulk as to comprcfs
the medullary fuhftance of the brain.

3. By the blood accumulated in. the bloocl-vefFels
of the Drain, and diflending them to fuch a degree as
to comprefs the medullary portion of the fame.

4. .By fluids effufed in different parts of the brain,
rr into lu: cavity of the cranium, and accumulated in
Lich tro ati:y as to occafion the compreiEon we treat
of.

And, as to this lad, it is to be remaiked here, that
the fluids effufed may be of two kinds : that is, they
may be either a portion of the coirirncn mafs of blood,
poured out fiom red veiTels ; or a portion of ferurn
• or colouilcfs fluid, poured out chiefly by the exha-
farits;

MCIV.

Of thefe feveral caufes of compreilion, the firlT: is
not ro be confidered here, becaufe the removing it does
not belong to our province ; and the confideration oi:'
the fecond may be omitted, as in moil inftances it is
neither to be difcerned nor cured by any means yet
known. The third and fourth caufes of compreiTion,
as they are the moil frequent, and are alfo moil pro-
perly the fubjects of our art, fo they are thofe which
deierve our particular attention ; and we mail there-
fore endeavour to trace them further back in the fe-
ries of caufes which may produce them.

MCV.

Both the flates of over-diftention and of efFufion,
tray be produced by whatever increafes the afflux and
impetus of the blood in the arteries of the head ; fuch
as violent exercife, a violent fit of anger, external heat

applied.

ya PRACTICE

applied, or any flrong preiTure upon the defcending
aorta.

MCVI.

But both thefe flates of over-cliftention and of efFu-*
fion, may alfo and feem to be more frequently produc-
ed by caufes that operate by preventing the free return
of the venous blood from the veiTels of the head to
the right ventricle of the heart.

MCVIL

The venous veitels of the brain are of a conforma-
tion and diftributionfo peculiar, as lead us to believe*
that Nature intended to retard the motion of the
blood, and accumulate it in thefe veffels ; and there-
fore, even very final I additional refinances to the mo-
tion of the blood from thefe towards the right ventri-
cle cf the heart, may Hill more readily accumulate
the blood in them. Such accumulation will moil
readily happen in advanced life, when the venous fyf-
tem in general is in a plethoric ftate, and when this
plethora takes place efpecially in the venous veffels of
the brain. It will, in like manner, be moil apt to oc-
cur in perfons whofe heads are large with refpect to
the reft of the body; and in perfons of a ihort neck,
which is unfavourable to the return of the venous
blood from the head. The accumulation of blood in
the venous veffels of the brain, will alfo be moft likely
to occur in perfons of a corpulent habit, either be-
caufe thefe may be considered to be in a plethoric
flute, or becaufc obciity, by occalioning a compreffion
of the blocd-vefTels in other parts of the body, more
readily fills thofe of the brain, which are entirely free
from any fuch coinpreflion.

MGVIII.

Thefe are the circumftances in the constitution of
the body, which, producing a (lower motion and re-
turn of the venous blood from the vefiels of the head,
favour an accumulation and difbntion in them ; and

we

OFPHYSIC. 73

we now proceed to mention the feveral occaflona!
caufes, which, in every perfon, may dire&ly prevent
the free return of the blood from the vefTels of the
head towards the heart. Such are,

1. Stooping down with the head, or other fitua-
tions of the body in which the head is long kepi; in a
depending (late, and in which the gravity of the blood
increafes the afflux of it by the arteries, and oppofes
the return of it by the veins.

2. A tight ligature about the neck, which compreiT-
es the veins more itrongly than the arteries.

3. Any obfittidUon of a coniiderable number of the
veins carrying the blood from the head, and more
efpecially any confiderable obilruction of the afcend-
ing vena cava.

4. Any confiderable impediment of the free paf-
fage of the blood from the veins into the right ventri-
cle of the heart ; and it is commonly by this, and the
immediately preceding circumftance, that polypous
concretions in the cava, or right ventricle, are found
to occalion apoplexy.

5. The return of blood from the veins of the head
towards the heart, is efpecially interrupted by every
circumftance that produces a more difficult tranfmif-
iion of the blood through the veiTels of the lungs. It
is well known, that, at the end of every expiration,
fome interruption is given to the free tranfmiffion of
the blood through the lungs ; and that this at the fame
time gives an interruption to the motion of the blood
from the veins into the right ventricle of the heart.
This clearly appears from that regurgitation of the
blood in the veins, which occaiions the alternate heav-
ing and fubliding that is perceived in the brain of liv-
ing animals when the cranium is removed, and which
is obferved to be fynchronous with the alternate mo-
tions of refpiration. From this we readily perceive,
that whatever occaiions a difficulty in the tranfmiffion

VOL. II. K of

74 PRACTICE

of the blood through the lungs, muft alfo interrupt
the free return of the venous blood from the vciTels
of the head ; and muft therefore favour, and perhaps
produce, an accumulation of blood, and an over-dif-
tention in thefe veflels.

It is further to be obfcrved, that as a very full in-
fpiration, continued for any length of time, occalions
fuch an interruption of the free tranfmiffion of the
blood through the lungs, as produces a fuffufion of
face, and a manifeft turgefcence of the blood- veffcls
of the head and neck ; fo every full, and long-conti-
nued infpiration may occafion an accumulation of
blood in the yelTels of the head, to a very confidera-
ble degree. Thus, as every ftrong exertion of the
mufcular force of the body requires, and is attended
with, a very full and long-continued infpiration, we
thence learn why the violent exertions of mufcular
force have been fo often the immediate or exciting
caufes of apoplexy.

It may alfo be remarked, that corpulency and obe-
fity operate very much, by occafioning a more difficult
tranfmiffion of the blood through the verTels of the
lungs. It appears, that in fat perfons, from the com-
preilion of the blood-vefTels in many parts of the bo-
dy, the velTels of the lungs are thereby kept very full ;
fo that, upon the leaft increafe of bodily motion,
which fends the blood fader into the lungs, a more fre-
quent and laborious refpiration becomes in fuch per-
fons immediately necefTary. This fhows, that, in fuch
perfons, the blood is not freely tranfmitted through
the lungs ; a circumftance which, as in other inftances,
muft give a conftant refiftance to the return of blood
from the veffels of the head, and therefore favour or
occafion an accumulation of blood in them.

Is the motion of the blood in the veffels of the head
rendered flower by ftudy, care and anxiety ?

MCIX.

0 F P H Y S I G. 75

MCIX.

It is to be obferved further, that thefe feveral cauf-
.es (MCV — MCVIII.) of a preternatural fuinefs in the
-blood- vefleis of the brain, may produce apoplexy in
different ways, according as the fuinefs takes place in
the arteries or in the veins.

MCX.

Accordingly, firft, the increafed afflux of blood in-
to the arteries of the brain,, and an increafed action in
thefe, may either occaiion a rupture of their extremi-
ties, and thereby an effufion of red blood producing
compreffion ; or the fame afflux and increafed action
may occafion an increafed exhalation from their ex-
tremities, of a ferous fluid, which, if not as quickly
re-abforbed, may foon accumulate in fuch quantity as
to produce compreffion.

MCXL

Secondly, The phletoric ft ate of the venous veflels
of the brain, may operate in three different ways.

1. The fuinefs of the veins may give fuch refiftance
to the blood flowing into them from the arteries, as
to determine the impetus of the blood to b$ f ) much
greater upon the extremities of the arteries as to occa-
fion a rupcure of thefe, and confequently an eiFuiion
of red blood, or the Hcemorrhagia ctrebri, which
HOFFMAN considers as a frequent caufe of apoplexy,
and which we have before explained in DCCLXXIT.

2. Whilft the fame refiftance to the blood flowing
from the arteries into the veins, increafes the impetug
of the blood in the former, this may, without occafi-
oning rupture, increafe the exhalation from their ex-
halant extremities, and produce an efFufion of a ferous
fluid ; in the fame manner as fuch refinance in the
veins produces hydropic effuiions in other parts of the
body.

3. If we may fuppofe, as no lymphatics have been
yet difcpvered in the brain, that the ordinary abforb-

K 2 ents

76 PRACTICE

ents are not prefent there, and that the exhaled fluids
are abforbed or taken up by the extremities of the
veins ; this will {how ftill more clearly that a refift-
ance to the motion of the blood in the veins of the
brain, may readily produce an accumulation of ferous
fluid in its cavities, and confequcntly a compreffion
producing apoplexy.

MCXIL

Befides thefe caufes of apoplexy from afflux in the
arteries, or refiftance in the veins, an effufion of ferirm
may happen from two other caufes. The one is a
relaxation of the exhalants, as in other cafes of hy-
dropic diatheiis prevailing in the body ; and it is not
unufual for a general dropfy to end in apoplexy. The
fecond is an over-proportion of watery parts in the
mafs of blood, which is therefore ready to run off by
the exhalants, as in the cafe of an ifchuria renalis ;
which, when it proves incurable, very commonly ter-
minates in apoplexy.

MCXIIL

We have now mentioned the feveral caufes of apo-
plexy depending upon compreffion ; and from the
whole it will appear, that the moft frequent of all
thefe caufes is a plethoric ftate, or an accumulation
and congeftion of blood in the venous veifels of the
head, operating, according to its degree, in produc-
ing over-ciiltention or effufion. The frequent opera-
tion of fuch acaufe will efpecially appear from acon-
iideration of the predifponent circumftances (MXCV.)
and from the antecedent fymptoms. (MXCVI.)

MCXIV.

From the view I have now given of the caufes of
apoplexy ariiing from compreffion, it will readily ap-
pear that there is a foundation for the common dif-
tinclion of this difeafe into the two kinds of Sanguine
and Serous. But this diftin&ion cannot be very ufe-
fully applied in pra&ice, as both kinds, may often de-
pend

OF PHYSIC. 77

pend on the fame caufe, that is, a venous plethora, and
therefore requiring very nearly the fame method of
cure, The only diftinction that can be properly made
of apoplexies from cornpreffion, is perhaps tiie difc
tinchon of ferous apoplexy, into that depending on
the plethora mentioned MCXIII. and that depending
upon hydropic diathefis, or an over-proportion of wa-
ter in the blood (MCXII.) the former caufes giving, a
proper idiopathic, the latter only a fymptomatic, dik
•eafe.

MCXV.

Befidethe caufes now mentioned, occaficning apo-
plexy by compreffion, I alledge there are other caufes
producing the fame difeafe, by directly deftroying the
mobility of the nervous power. Such caufes feem to
be the mephtic ariiing from fermenting liquors, and
from many other fources ; the fumes ariiing from
burning charcoal, the fames of mercury, of lead* and
of fame other metallic fubftances ; opium, alcohol,
and many other narcotic poifons : To all which I
would add the power of cold, of concuffion, of electri-
city, and of certain paflions of the mind.
MCXVI.

None of thefe pcifons or noxious powers feem to
kill by acting firfl upon the organs of refpiration, or
upon the fanguiferous fyftem ; and I believe their im-
mediate and direct action to be upon the nervous pow-
er, deftroying its mobility, becaufe the fame poifons
{how their power in deflroying the irritability of muf-
cles and of the nerves connected with them, when
both thefe are entirely feparated from the reft of the
body.

MCXVII.

It appears to me probable that the apoplectic flats
infome degree accompanying, and al moil always fuc-
ceeding, an epileptic paroxyfrn, does not depend upon
compreflion? but upon a certain flateof immobility of

the

3 PRACTICE

the nervous power, produced by certain circumftan-
ces in the nervous fyftem itfelf, which fometimes fcem
to be communicated from one part of the body to ano-
ther, and at length to the brain.
MCXV1II.

The fame obfervation may be made with refped to
many inftances of hyfteric paroxyfm ; and the circum.
fiances, both of epileptic and hyfteric paroxyfms, end-
ing in coma, or a degree of apoplexy, lead me to
think, that alfo the apoplexy proceeding from retro-
cedent or atonic gout is of the fame kind, or that it
depends upon an immobility of the nervous power,
rather than upon compreflion.
MCXIX.

It may indeed happen, that as the apoplectic and
gouty pred if pofi dons do often concur in the fame
perfon ; fo it may frequently happen, that the apo-
plexy coming upon gouty perfons, may fometimes de-
pend upon compreflion ; and diffeftions may, accord-
ingly, difcover that the circumftances of fuch a caufe
had preceded. But, in many cafes of apoplexy fol-
lowing a retrocedent, or atonic gout, no fuch antece-
dent or concomitant circumftances, as commonly oc-
cur in cafes of compreffion, do diftin&ly or clearly ap-
pear; while others prefent themfelves, which point
out an affection of the nervous power alone.

MCXX.

With refpect, however, to the circumftances which
may appear upon the direction of perfons dead of a-
poplexy, there may be fome fallacy in judging, from
thofe circumftances, of the caufe of the difeafe.
Whatever takes off or diminifhes the mobility of the
nervous power, may very much retard the motion of
the blood in the veflels of the brain ; and that perhaps
to the degree of increafing exhalation, or even of oc-
caiioning rupture and cffufion : fo that, in fuch cafes,
the marks of compreflion may appear, upon difledion,

though

O F P H Y S I C. 79

though the difeafe had truly depended on caufes de-
ftroying the mobility of the nervous power. This
feems to be illuftrated and confirmed from what oc-
curs in many cafes of epilepfy. In fome of thefe, af-
ter a repetition of fits, recovered from in the ufual
manner, a fatuity is induced, which commonly de-
pends upon a watery inundation of the brain : And
in other cafes of epilepfy, when fits have been often
repeated without any permanent confequence, there
happens at length afatalparoxyfm; and upon diiTcdtion
it appears, that an effufion of blood had happened. This,
Ithink,istobeconfideredasacaufeofdeath, notasacaufe
of the difeafe : for in fuch cafes, I fuppofe that the
difeafe had diminifhed the aclion of the velTels of the
brain, and thereby had given occafion to a flagnation,
Which produced the appearances mentioned. And I
apprehend the fame reasoning will apply to the cafes
of retrocedent gout, which, by deflroying the energy
of the brain, may occafion fuch a ftagnation as will
produce rupture, effufion, and death ; and in fuch a
cafe, the appearances upon diffe&ion might lead us to
think that the apoplexy had depended entirely upon
compreflion.

MCXXI.

The feveral caufes mentioned in MCXV. are often
of fuch power as to occafion immediate death ; and
therefore have not commonly been taken notice of as
affording inftances- of apoplexy ; but, as the operation
of the whole of thefe caufes is fimilar and analogous,
and as in moft inftances of the operation of thefe caufes
an apoplectic ftate is manifestly produced, there can
be little doubt in confidcring mod of the inftances of
their effects as cafes of apoplexy, and therefore fuch
as fall properly under our confideration here.
MCXXIl,

This difeafe of apoplexy is fometimes entirely re-
covered from ; but more frequently it ends in death,

or

So P R A C T ICE

or in a hemiplegia. Even when an attack of the dlf-
eaie is recovered from, we generally find it diipofed
to return ; and the repeated attacks of it almoii al-
ways, iboner or later, bring on the events we have
mentioned.

MCXXIII.

The feveral events of this difeafe, in health, death,
or another difeafe, may be expected and forefeen from
a confideration of the predilponent circumftances
(MXCV,); of the antecedent fymptoms (MXCVI.) ; of
the exciting caufes (MXCVIII.); of the violence and
degree of the fymptoms when the difeafe has corne on
(MXCIV.) ; of the duration of the difeafe ; and of the
effects of the remedies employed.
MCXXIV.

From the great danger attending this difeafe when
it has come on (MCXXU.), it will readily appear that
our care fhould be chiefly directed to the prevention
of it. This, I think, may be often done by avoiding
the remote and exciting caufes ; and how this may be
accomplished, will be obvious from the enumeration
of thofe caufes given above (MXCVIII.) But it will alfo
appear from what is faid above, that the prevention
of this difeafe will efpecially depend upon obviating
the predilponent caufe ; which, in moft cafes, feems
to be a plethoric (late of the blood- veffels of the brain.
This, I think, may be obviated by different means ;
and, in the firft place, by a proper management of ex-
ercife and diet.

MCXXV.

The exercife ought to be fuch as may fupport the
perfpiration, without heating the body or hurrying ref-
piration ; and, therefore commonly by fome mode of
geitation. In perfons not liable to frequent iits of
giddinefs, and who are accuftoirr- J to riding on horfe-
back, this exercife is, of all others, the belt. Walk-
ing, and fome other modes of bodily exercife, may be

em-

O F P H Y S I C. Si

employed with the reftriclions jufl now mentioned ;
but in old men, and in men of corpulent habits, bodi-
ly exercife ought always to b'e very moderate.
MCXXVL

In perfons who pretty early in life (how the predif-
poiition to apoplexy, it is probable that a low diet,
with a good deal of exercife, might entirely prevent
the difeafe ; but, in perfons who are advanced in life
before they think of taking precautions, and are at the
fame time of a corpulent habit, which generally iup*
pofes their having been accuftomed to full living, it
might not be fafe to put them upon a low diet : and
it may be enough that their diet be rendered more
moderate than ufual, efpecially with refpeft to animal-
food ; and that, at fupper, fuch food ihould be ab-
ftained from altogether.

In drinking, all heating liquors are to be abftained
from, as much as former habits will allow ; arid the
fmalielfc approach to intoxication is to be carefully
ihunned. For ordinary draught, fmall beer is to be
preferred to plain water, as the latter is more ready to
occaiion coflivenefs, which in apoplectic habits is to be
carefully avoided. The large ufe of tobacco in any
fliape may be hurtful ; and except in cafes where it
has been accuftomed to occaiion a copious excretion
from the head, the interruption of which might not
be fafej the ufe of tobacco ihould be avoided ; and
even in thecircumftance mentioned, where it may be
in fome meaning neceflary, the ufe of it fhould at lead;
be rendered as moderate as poflible.
MCXXV1I.

Evacuations by flool may certainly contribute to
relieve the plethoric fcateof the veifels of the head ;
and, upon appearance of any unufual turgefcence in
thefe, purging will be very properly employed : but,
when no fuch turgefcence appears, the frequent repe-
tition of large purging might weaken the body too

VOL. II. L much;

82 PRACTICE

much ; and, for preventing apoplexy, it may for the
mod part be enough to keep the belly regular, and
rather open, by gentle laxatives*. In the fummer
fealon, it may be ufeful to drink, every morning, of
a gentle laxative mineral 'water, but never in large
quantity.

MCXXVJII.

In the cafe of a plethoric ft ate of the fyflem, it
might be fuppofed that blood-letting would be the
moil effectual means of diminifhing the plethora, and
of preventing its confequcnces ; and, when an attack
of apoplexy is immediately threatened, blood-letting
is certainly the remedy to be depended upon ; and
blood mould be taken largely, if it can be done, from
the jugular vein, or temporal artery. But, when
no threatening turgefcence appears, the obviating
plethora is not judicioufly attempted by blood-let-
ting, as we have endeavoured to demonftrate above,
DCCLXXXVU. In doubtful circumftances, leeches ap-
plied to the temples or icarifications of the hind-head,
may be more fafe than general bleedings.

MCXXIX.

When there are manifeft fymptoms of a plethoric
Hate in the veifels of the head> a feton, or pea-ifliie,
near the head, may be very ufeful in obviating any
turgefcence of the blood.

MCXXX.

Thcfe are the means to be employed for preventing

the

* Gentle laxatives have been often enumerated in the preceding
notes. In. thefe cafes, however, there is no danger to be apprehend-
ed from the ufe of the refmous draftics, provided that they are not
given in fuch dofes as may weaken the patient too much. They
ought to be ufed for the purpofe of purging, but only for keeping
the body moderately open ; and this eftc6t may be fafely produced
by five or eight grains of Rufus's pills taken occafionally at bed-time,
or by a tea-fpoonful or two of the Tinct. jalap, or a table -fpoonful
of the elixir fennae in the morning. The fame end may, in many
f afes, be anfwered by a due attention to diet.

O F P H Y S I C. 83

the apoplexy which might arife from a plethoric ftate
of the veflels of the brain; and if, at the fame time,
great care is taken to avoid the exciting caufes (MXC-
vm.), thefe means will be generally fuccefsful.

In the cafes proceeding from other caufes (MCXV.),
as their application is fo immediately fuccceded by
the difaafe, they hardly allow any opportunity for pre-
vention.

MCXXXI.

For the CURE of apoplexies from internal caufes,
and which I fuppofe to be chiefly thofe from comprefr
fion, the ufual violence and fatality of it require that
the proper remedies be immediately and largely em-
ployed.

The patient is to be kept as much as poffible in
fomewhat of an erect poflure, and in cool air, and
therefore neither in a warm chamber, nor covered
with bed-clothes, nor furrounded with a crowd of
people.

MCXXXII.

In all cafes of a full habit, and where the difeafe
has been preceded by marks of a plethoric ftate, blood-
letting is to be immediately employed, and very large-
ly. In my opinion, it will be moil effectual when the
blood is taken from the jugular vein ; but if that can-
not be properly done, it may be taken from the arm.
The opening of the temporal artery, when a large
branch can be opened, fo as fuddeniy to pour out a
confiderable quantity of blood, may alfo be an effectu-
al remedy ; but, in execution, it is more uncertain,
and may be inconvenient. It may be, in fome mea-
fure fupplied, by cupping and fcanfyingon the tem-
ples or hind-head. This, indeed, fhould feldom be
omitted : and thefe fcarifications are always prererable
to che application of leeches.

With refpect to every mode of blood-letting, this
is to be obferved, that when in any cafe of apoplexy,

L 2 ' it

S4 PRACTICE

it can be perceived that one lide of the body is more
affefted with the iofs of motion than the other, the
blood-letting, if poffible, fhould be made on the fide
oppoiite to that moil affected*.

MCXXXIII.

Another remedy to be employed is purging, to be
immediately attempted by acrid glyfters§ ; and at
the fame time, if any power of fwallowing remain,
by draftic purgatives given by the mouth. Thefe,
however, left they may excite vomiting, fhouldbe
given in divided portions at proper intervals-}*.
MGXXX1V. .

Vomiting has been commended by forne pracli-
tioners and writers: but, apprehending that this might

impel

* DifTe&ions (hew that the congestions producing apoplexy are al-
ways on the fide not affected; and hence the propriety of the direction,
§ Acrid clyfters are,

&. EleA. lenitiv. Ji.*

Sal, cathartic, amar. Jiifs.
Aq. tepid. §xi.
M. f. Enema.
R. Sapcm. alb. ^ifs.

Solve in aq. tepid, jx. cui addc
Syr. e ipina cerv. ^ii.
M. f. Enema.
R. Pulp, colocynth. §iii.

Coque per horse quadrantem in nq. font.

q. f- ad colutarse ^xii. cui adde
Oi. Olivar. 51.
M. f. Enema,

•f- The draftic purges are, in thefe cafes, to be given in draughts,
rather than in pilis or bohifes ; the following form may be uicd ;
$. Pulv. jalap. 5i.
Rad, zinzib. 3i-
Infuf, ftrn. liui tiii.'
M.

The dofe of this mixture is two fpoonfiu'j every two hours li«l it o-
peratc : or we may ufe one of the formulae mentioned in the note
on article 1080, especially the laii, repeating it every two hours till
it produces an effect.

O F P H Y S I G. 85

impel the blood with too much violence into the vef-
fels of the head, I have never employed it.

MCXXXV.

Another remedy to be immediately employed is
"bliftering ; arcl 1 judge that this is more effectual when
applied to the head, or near to it, than when it is ap-
plied to the lower extremities. This remedy I do
not corifider as a ftimulant, or capable of making any
confide; able revulfion ; but, applied to the head, I
fuppofe it ufeful in taking off the hemorrhagic difpo-
litionfo often prevailing there.

MCXXXVI.

It has been ufual with practitioners, together with
the remedies already mentioned, to employ ftimulants
of various kinds ; but I am difpofed to think them
generally hurtful; and they mult be fo, wherever the
fulnefs of the vefieh, and the impetus of the blood in
thefe, is to be diminiihed. Upon this principle it is
therefore agreed, that itimulants are abfolutely impro-
per in what is fuppofed to be a fanguine apoplexy ;
but they are commonly fuppofed to be proper in the
ferous. If, however, we be right in alledging that
this alfo commonly depends upon a plethoric flate of
the blood-velfels of the brain, ftimulants mufl be
equally improper in the one cafe as in the other.
MCXXXVII.

It may be argued from the almofl univerfal employ-
ment of ftimulants, and fometimes with feeming ad-
vantage, that they may not be fo hurtful as my no-
tions of the caufes of apoplexy lead me to fuppofe.
But this argument is, in feveral refpeds, fallacious ;
arid particularly in this, that in a difeafe which, un-
der every management, often proceeds fo quickly to,
a fatal termination, the effects of remedies are not to be
eafily afcertained.

MCXXXVIII.

I have now mentioned the feverai remedies which

I think

86 PRACTICE

I chink adapted to the cure of apoplexy arifmg
from compreffion, and fhould next proceed to
treat: of the cure of apoplexy ariiing from thofe
caufes that directly deftroy the mobility of the
nervous power. But many of thofe caufes are often
fo powerful, and thereby fo fuddenly fatal in their ef-
fe6ts, as hardly to allow of time for the ufe of reme-
dies ; and fuch caH s, therefore, have been fo feldom
the fubjc&s of prn&ice, that the proper remedies are
not fo well afceriained as to enable me to fay much of
them here.

MGXXXIX.

When, however, the application of the caufes,
(MCXV.) is not fo powerful as immediately to kill, and
induces only an apoplectic ftate, fome efforts are to be
made to obviate the confequences, and to recover the
patient ; and even in foaie cafes where the caufes re-
ferred to, from thecealing of the pulfe and of refpira-
tion, and from a coldnefs coming upon the body, have
induced an appearance of death ; yet, if thefe appear-
ances have not continued long, there may be means of
recovering the perfons to life and health. I cannot,
indeed, treat this fubject completely j but for the cure
of apoplexy from feveral of the caufes mentioned
MCXV, fnall offer the following general directions.

1. When a poiibn capable of producing apoplexy
has been recently taken into the ftomach, if a vomit-
ing fpontaneouily arifes, it is to be encouraged ; or, if
it does not fpontaneoufly come on, a vomiting is to be
immediately excited by art, in order that the poifon
may be thrown out as quickly as poflible. If, howe-
ver, the poifon has been taken into the.ilomach long
before its effects have appeared, we judge that, upon
their appearance, the exciting of vomiting will bs
ufelefs, and may perhaps be hurtful.

2. When the poifon taken into the ftomach, or
otherwife applied to the body, has already induced a,n

apo-

O F P H Y S I C: 87

apoplectic ftate, as thofe caufes do commonly at the
fame time occafion a ftagnatron or flower motion of
the blood in the vtflels of the brain and of the lungs,
fo it will generally be proper to relieve this congdtion
by taking fome blood from the jugular vein, or from
the veins of the arm.

3. Upon the fame fuppolition of a congeftion in the
brain or lungs, it will generally be proper to relieve it
by means of acrid glyfters producing fome evacuation
from the inteftines.

4. When thefe evacuations by blood-letting and
purging have been made, the various ftimulants which
have been commonly propofed in other cafes of apo
plexy, may be employed here with more probability
and fafety*. One of the mofl effectual means of rouf-
ing apoplectics of this kind feerns to be throwing cold
water on feveral parts of the body, or warning the bo-
dy all over with it.

5. Although the poifon producing apoplexy hap-
pens to be fo powerful as very foon to occafion the ap-
pearances of death above-mentioned ; yet if this ftate
has not continued long, the patient may ofcen be re-
coverable ; and the recovery is to be attempted by the
fame means that are directed to be employed for the
recovery of drowned perfons, and which are now
commonly known.

CHAP.

k The ftimulants arc various according to the various parts of the
body to which they are generally applied, as volatile and vinous fpi-
rits, or vinegar, to the nofe an.i temples ; acrid cfiVntial oils, mixed
with thrice their weight in hog's lard, to ih •; buatl and back ; bli-
i:ters? hot finapifms, and warm fomentations, wkri t'orfe-radifh, to the
extremities ; frictions with warm brushes ; the aihial cautery to the
foles of the fee:, and palms of the hands; with frveral others, which
are more particularly defcribed in the notes on article 1161, et feq.

PRACTICE

CHAP. II.
O $ PALSY.

MCXL.

ALSY js a difeafe confiftkigin a lofs of the pow-
er of Voluntary motion, but affecting certain
parts of the body only, and by this it is diftinguifhed
from apoplexy. (MXCIV.) One of the moil frequent
forms of palfy is when it affecls the whole of the muf-
cles on one fide of the body ; and then the difeaic is
named a Hewpkgia.

MCXLI.

The lofs of the power of voluntary motion inr.y
be owing either to a morbid affection of the mufcles or
organs of motion, by which they are rendered unfit
for motion ; or to an interruption of the influx of the
nervous power into them, which is always necefikry
to the motions of thoie that are under the power of
the will. The difeafe, from the fir it of theie caufes,
as confifting in an organic and local affect ion, we refer
entirely to the clafs of local difeafes. I am here to
confider that difeafe only which depends upon the in-
terrupted influx of the nervous power ; and it is to
this difeafe alone I would give the appellation of
Palfy. A difeafe depending on an interrupted influx
of the nervous power, may indeed ofcen appear as
merely a local affection ; but as it depends upon an
affection of the mod general powers of the fyftem, it
cannot be properly ieparatcd from the fyfteinatic af-
fections.

MCXL1L

In palfy, the lofs of motion is often accompanied
with the lofs of fenfe ; but as this is not constantly the
cafe, and as therefore the lofs of fenfe is not an effen-

tial

OF PHYSIC. 89

tial fymptom of palfy, I have not taken it into my defi-
nition (MCXL.); and I fhall not think it neceffary to
take any further notice of it in this treatife ; becaufe,
in fo far as it is in any cafe a part of the paralytic af-
feclion, it mud depend upon the fame caufes, and
will be cured alfo by the very fame remedies, as the
lofs of motion.

MCXLIIL

The palfy then, or lofs of motion, which is to be
treated of here, may be diftinguifhed as of two kinds ;
one of them depending upon an affe&ion of the origin
of the nerves in- the brain, and the other depending
upon an affe&ion of the nerves in fome part of their
courfc between the brain and the organs of motion.
Of the latter, as appearing in a very partial affection,
I am not to fpeak particularly here ; I ihall only
treat of the more general paralytic affections, and ef-
pecially of the hemiplegia (MCXL.) At the fame time
I expect, that what I Ihall fay upon this fubject will
readily apply to both the pathology and practice in
the cafes of affections more limited.

MCXLIV.

The hemiplegia (MCXL.) ufually begins with, or
follows, a paroxyfm of apoplexy ; and when the he-
miplegia, $fter fubfifting for fome time, becomes fatal,
it is commonly by pafling again into the (late of apo-
plexy. The relation therefore or affinity between the
two difeafes, is iufficiently evident ; and it is further
ftrongiy confirmed by this, that the hemiplegia comes
upon perfons of the feme conftitution (MXCV.), and is
preceded by the fame fymptoms (MXCVIII.), that have
been taken notice of with refpect to apoplexy.

MCXLV.

When a fit of apoplexy has gone off, and there re-
mains a (late of palfy appearing as a partial aff.c^ion
only, it might perhaps be fuppofed that the origin
of the nerves i> in a grtai meafuie relieved; but in fo
VOL. II. M far

9C5

PRACTICE

far as commonly there flill remain the fymptoms of
the lofs of memory, and of fome degree of fituity,
thefc, I think, (how, that the organ of intellect, or
the common origin of the nerves, is flill coniiderably
affeded.

MCXLVI.

Thus, the hemiplegia, from its evident conne&icn
with, and near relation to, apoplexy, may he properly
conlidered as depending upon like cauies ; and con-
fequently, either upon a compreffion preventing the
flow of the nervous power from the brain into the or-
gans of motion, or upon the application of narcotic or
other powers (MCXV.) rendering the nervous power
unfit to How in the uftial and proper manner.
MCXLVIl.

We begin with confidering the cafes depending upon
comprefiion.

The comprefiion occafioning hemiplegia may be of
the fame kind, and of all the different kinds that pro-
duce apoplexy ; and therefore either from tumour,,
over-diftenfion, or effufion. The exigence of tumour
giving compreffion, may often be better difcerned in
the cafe of palfy than in that of apoplexy, as its effects
often appear atfirfl in a very partial affection*
MCXLVIIL

The other modes of compreffion, that is, of over-
diftenfion and effufion, may, and commonly do, take
place, in hemiplegia : and when they do, their opera-
tion here differs from that producing apoplexy, by its
effecls being partial, and on one fide of the body only.

It nay fe^m difficult to conceive that an over-dif-
tcnficn can take place in ^he veflHs on one fide of the
brain only ; but it may be underflood : and in the cafe
oi a paiiy which is both partial and tranlitory, it is per-
haps the only condition of the vefTels of the brain th-.it
can be fuppofed, In a hemiplegia, indeed, which fub-
fiftsfor any length of time, there is probably always

an

O F P H Y S I C. 91

an effufion, either fanguine or ferous : but. it is likely
that even the latter muft be iupported by a remaining
cono-eftion in the blood-veilels.
MCXLIX.

That a fanguine effufion can happen without be-
.coming very fbon general, and thereby occasioning
apoplexy and death, may alfo feem doubtful : but, dii-
fedions prove that in fad it does happen occafioning
palfy only ; though it is true, that this more com-
monly depends upon an effufion of ferous fluid, and of
-this only.

MCL.

Can a palfy, occaiioned by a compreffion, remain
though the comprefiion be removed* ?

MCL1.

From what has been faid MCXLIV. it will be obvious,
that the hemiplegia may be prevented by all the feve-
ral means propofed MCXXV. et. feq. for the prevention
iOf apoplexy.

MCLII.

Upon the fame grounds, the CURE of palfy mud be
iyery much the fame with that of apoplexy (MCXXX.
et.feq.')', and whep palfy has begun as an apoplexy,
it is prefumed, that, before it is to be confidered as
palfy, all thofe feveral remedies have been employed.
Indeed, even when it happens that on the firft attack
of the difeafe the apoplectic ftate is not very complete,
and that the very firft appearance of the difeafe is as a
hemiplegia, the affinity between the two d'feafes
.(MCXLIV.) is fuch as to lead to the fame remedies in
both cafes. This is certainly proper in all thofe cafes
in which we can with much probability impute the dif-

M 2 eafe

* This quefiion may be anfwered in the affirmative ; hecaufc the
fttufture of the nerve may be deltroyed by the comprtfiion, and the
•nerve may therefore remain impervious to the newuus in uence, after
the compremon has been removed.

92 PRACTICE

cafe to compreffion ; and it is indeed feldom that a
hemipiegia from internal caufes comes on but with a
confiderable affection of the internal, and even of the
external fenfes, together with other marks of a com-
preilion of the origin of the nerves.

MCL1II.

Not only, however, where the difeafe can be im-
puted to compreffion, but even where it can be im-
puted to the application of narcotic powers, if the dif-
eafe come on with the appearances mentioned at the
end of laft paragraph, it is to be' treated in the fame
manner as an apoplexy by MCXXXI — Mcxxxrx.

MCL1V.

The cure of hemipiegia, therefore, on its fir ft at-
tack, is the fame, or nearly the fa;ne, with thai of apo-
plexy : and it feems requifite that it mould be different
only, i. When the difeafe has fubiifted for fome
time; 2. When the apoplectic fymptoms, or thofe*
marking a confiderable compreffion of the origi - of
the nerves, are removed ; and particularly, 3. When
there are no evident marks of compreffion,, and it i^at
the fame time known that narcotic powers have been
applied.

MCLV.

In all thefe cafes, the queftion arifes, Whether fti-
mulants may be employed, or how far the cure may
be entirely trufted to fuch remedies ? Upon this qnef-
tion, with rcfpecl to apoplexy, I have offered my opi-
nion in Mcxxxvr. And, with refpecl: to hemipiegia,
I am of opinion, that flimulants are almoft always e^
qually dangerous as in the cafes of complete apo-
plexy ; and particularly, i. In all the cafes of hemip-
iegia fucceeding to a paroxyfm of complete apoplexy ;
2. In all the cafes coming upon perfons of the temper-
am mr

* The mod infallible of thefe marks is, the intelle&ual faculties
not returning.

O F P H Y S I C. 93

ament mentioned in MXCV. and after the fame antece-
dents as thofe of apoplexy, (MCXVI.) and 3. In all
the cafes coming on with fympLoms of apoplexy from
compreflion,

MCLVI.

It is, therefore, in the cafes MCLI v, only, that ftimu-
lants are properly admifiible : And even in the two
full of thefe cafes, in which a plethoric ftate of the
blood-veflels of the brain may have brought on the
difeafe, in which a difpofitiontothat ftate may (till conti-
nue, and in which even fome degree of congeftion may
Hill remain, the ufe of ftimulants mufl be an ambiguous
remedy ; fo that perhaps it is in the third of thefe cafes
only that ftimulants are clearly indicated and admiffible.
MCLViL

Thefe doubts with refpeft to the ufe of ftimulants,
may perhaps be overlooked or difregarded by thofe
whoalledge that ftimulants have been employed with
advantage even in thofe cafes (MCLV.) in which I
have faid thev ought to be avoided.
MCLVIII.

To compromife this contrariety of opinion, I muft
obferve, that even in the cafes of hemiplegia depend-
ing upon compreffion, although the origin of the nerves
be fo much coirs preiTed as to pi-event fo full a flow of
the nervous power as •$ neceflUry to mufcular motion,
yet it app- v.rs from the y- ,wer of fenfe ft ill remaining,
thnt the nerves are, to a cor'ain degree, ftill previous ;
and therefore it is probable that ftimulants applied,
may excite the energy of the brain fo much, as in
fome me af Lire to force open the comprerTed nerves,
and to fiiow fome return of motion in paralytic muf-
cles. Nay, further, it may be allowed, that if thefe
ftimulants be fuch as acl more upon the nervous than
Mpon the fanguiferous fyftem, they may p -flibly be
employed without any very hurtful confequence.

MCLIX.

94 PRACTICE

MCLIX.

But fill! it will be obvious, that although certain
ilimulants act chiefly upon the nervous fyilem, yet
they alfo act always in forne meafure upon the fangui-
ferous ; fo that, when they happen to have the latter
effect in any conilderable degree, they may certainly
do much harm; and in a diiede which they do not
entirely cure, the rnifchief arifing . from them may
not be difcerned.

MCLX.

Whilft the employment of ftimulants is fo often an
ambiguous praclice, we may perhaps go fome length
towards afcertaining the matter, by confidering the
nature of the feveral ftimulants which may be employ-
ed, and fome of the circumftances of their adminiflra-
tion. TvVith this view therefore, I fhall now mention
the fever al ftimulants that have been commonly em-
ployed, and offer fome remarks upon their nature and
life.

MCLXI.

They are in the firft place to be diftingnifhed as ex-
ternal or internal. Of the firil kind, we again diftin-
guith them as they are applied to particular parts of
the body only, or as they are more generally appLed
to the whole fyftem. Of the firfl kind are,

i. The concentrated acids of vitriol or nitre ; in-
volved, however, in oily or un&ious fubftances, which
may obviate their corrofive, without deflroying their
ftimulant power*.

- 2. The

* Rubefaoient ointments arc competitions like the following :
§,. Axung. porcin. %n.
Acid vitriol. 3'-
M.

Or,

$?. Unguent, bafilic. flav. lii.
.Acid vitriol, gi.
M.
Thev foon reJdcn and inflame the fkin ; and, when this efFe^fi is pro-

OF PHYSIC. 95

2. The volatile alkaline fpirits, efpecially In their
cauftic ftate ; but involved alib in oils, for the purpofe
juft now mentioned*.

3. The fame volatile fpirits are frequently employ-
ed by being held to the nofe, when they prove a pow-
erful ilimulus to the nervous fyftem ; but it is at the
fame time probable, that they may alfo prove a ftrong
ftimulant to the blood -vefiels of the brain.

4. A brine, or ftrong folution of fea-faltf .

5. The eflential oils of aromatic plants J, or of ibeir
parts.

6. The eflential oils of turpentine, or of other fuch
refinous fubftances.

7. The diflilled oils of amber, or of other bitumin-
ous fo flils §.

8. The rectified empyreumatic oils of animal or ve-
getable fubftances || .

9. Va-

duced, they mud be taken off, and the part anointed with common
ointment, or with oil.

* The Linimenta volatilia of the Pharmacopoeias are not fo ftrong
as the following :

£>. Alkal. volatil. cauftic |i.
Ol. olivar, gii,
M.

In the new London Pharmacopoeia this competition is called L>
rmnentum Ammoniac Fortius.

f The brine that remains in the falt^pans, after the common fait
is cryftalized, is the moft effectual of thcfe briny ftimulants ; it is
called in Edinburgh Oil of Salt.

f The OI. Origani is generally ufed. It otight to be mixed with
fome unduous oil, as in the following formula :
&. Ol Origan. 3!!.
Axung. porcin. giv.

M;

The aromatic oils di(Folved in fpirits make an elegant application ;
but thediftilled fpirits of the plants themfelves ?re more in ufe.

§ They are generally ufed with hog's-lanl, in the proportion of
eight times their quantity of lard. Some practitioners, however,
take only twice the qviantity of lard ; but they are not fo effectual
as fome of the rubefacienf? above enumerated,

{] The ufe of thefe empyreumatic oils is not fo frequent now a*

S>6' PRACTICE

9. Various vegetable acrids, particularly muftard*.

10. The acrid matter found in feveral infects, par-
ticularly can thar ides f .

Some of thefe flimulants may be either applied in
fubftarice ; or may be diiTolved in ardent fpirits, by
which their flimulant power may be increafed, or
more conveniently applied.

MCLXII.

The greater part of the fubiiances now enumerated
fhow their ftimulant power by inflaming the fkin of
the part to which ihey are applied ; and when their
application is fo long continued as to produce this ef-
fect ; it interrupts the continuance of their ufe ; and
the inflammation of the part does not feem to do fo
much good as the frequent repetition of a more mode-
rate ftimulus.

MCLXIII.

Analogous to thefe (limulants is the flinging of net-
tles, which has been frequently recommended.

Among the external ilimulants, the mechanical one
of friction with the naked hand, the flefh-brufh, or
flannel, is juflly to be reckoned. Can the impregna-
tion of the flannels to be employed, with the fumes
of burning maflic, olibanuni, &c. be of any fervicef ?

MCLXV.

formerly; they are extremely acrid, and if not ufed with caution,
often corrode the fkin

* The form, ih which the flour of muftard is ufed, is called a fi-
napifm. it is mixed with an equal quantity'of bread-crumb or oat-
meal, and made into a paile with vinegar. Some practitioners add
bruifed garlic, in tlis proportion of one fourth of the quantity of mu-
liard ; but it is extremely otTeniiw, and the cataplafiu without it an-
fwers fofficicntly well.

•j- Thefe infects are the bafis of bHHering plaflersand ointments.

J Many practitioners have thought Ui-r <\ich impregnations have
been of fm^ular fcrvice. The fumes of iv.o!l of thefe refins are ei-
ther flowers, as th'*y are celled in the fri^r . or e'feutial oils, Loth
of which ire Rimulating, and may tlierefore be fuppofed to be active.

Tlic impregnating flannels or ficfli-brulhes with flour of oiuflard is
often ufrd, and afliftsconliderably in bringing on an inflammation.

OF PHYSIC. 97

MCLXIV.

With refpecl: to the whole of thefe external ftimu-
lanrs, it is to be obferved, that they affed: the part to
which they are applied much more than they do the
whole fyftem, and they are therefore indeed fafer in
ambigu* us cafes; but, for the fame reafon, they are
of lefs efficacy in curing a general affe&ion.
MCLXV.

The external applications which may be applied to
affect the whole fyltem, are the powers of heat and
col.i, and of electricity.

Heat, as one of the moft powerful flimulants of the
animal ceconomy, has been often employed in palfies,
efpecially by warm bathing. But as, both by fiimu-
lating the iblids and rarefying the fluids, this proves a
ftrong ftimulus to the fanguiferous fyftem, it is often
an ambiguous remedy ; tind has frequently been ma-
nifeitly hurtful in palfies depending upon a congeftion
of blood in the verfels of the brain. The moft certain,
and therefore the moft proper ufe of warm bathing
in palfies, feems to be in thofe that have been occafi-
oned by the application of narcotic powers. Are the
natural baths more ufeful by the matters with which
they may be naturally impregnated*.
MCLXVI.

Cold applied to the body for any length of time, is
always hurtful to paralytic perfons : but if it be not
very intenfe, nor the application long continued, and
if at the fame time the body be capable of a briik reac-

VOL. II. N ticn,

* The natural baths contain fo fmall a quantity of impregnating
fubftances as induces us to lufpeft that they cannot kave any benefi-
cial powers fuperior to thofe of ordinary warm baths.

The ufe of warm baths ought not to be promifcuous. In cafes of
palfies, arifing from certain poifons, as the fumes of arfenic or metals,
and their ores ; the warm baths feldom fail of procuring relief; and
fome inftances have been given by authors, of complete cures having
been performed by the ufe of baths alone.

$8 P R A -C T I C E

tion, fuch an application of cold is a powerful flimrr*
lant of the whole fyftem, and has often been ufeful in
curing palfy. But, if the power of reaction in the bo-
dy be weak, any application of cold may prove very
hurtfulf.

MCLXVII.

Eleftricity, in a certain manner applied, is'eertain-
ly one of the moil powerful fthnulants that can be em-
ployed to act upon the nervous fyftein of animals;
and therefore much has been expected from it in the
cure of palfy. But, as it ftimulates the fanguiferous
as well as the nervous fyftem, it has been often hurt-
ful in palfies depending upon a comprefli >n of the
brain ; and efpecially when it has been fo applied as
to aft upon the vefTels of the head. It is fafer when
its operation is confined to particular parts fomewhat
remote from the head ; and, further, as the operation
of electricity, when very ftrong, candeftroy the mobi-
lity of the nervous power. I am of opinion, that it
is always to be employed with cauiion, and that it is
only fafe when applied with moderate force, and when
confined to certain parts of the body remote from the
head. It is alfo my opinion, that its good effects are
to be expected from its repetition rather than from
its force, and that it is particularly fuited to the cure
of thofe palfies which have been produced by the ap-
plication of narcotic powers.

MCLXVIII.

Amongft the remedies of palfy, the tife of exercife
is not to be omitted. ' In a hemiplcgia, bodily exer-
cife cannot be employed ; and in a more limited af-
fection, if depending upon a compreffion of fame part
of the brain, it would be an ambiguous remedy ; but,

in

* The very great uncertainty of the power of rea&ion always
makes the application of cold a very doubtful remedy ; and, as it is
evidently hurtful, wherever the rea&fon is weak, it ought to be ufod
with extreme caution,

OF P JH Y S I Q, 99

*$ all cafes where the exercifes of geftation can be em-
pjoyed, they are proper ; as, even in cafes of compref-
lion, the itimulus of fuch exercife is moderate, and
therefore fafe ; and, as it always determines to the
furface of the body, it is a remedy in all cafes of in-
t£rnal congcftion.

MCLXIX.

The internal ftirnukms employed in palfy are vari-
ous, but chiefly the following.

1. The volatile alkaline falts, or fpirits, as they are
called, are very powerful and diuufi.ve flimulanu, ope-
rating efpecialiy on the nervous fyfteni*; and even al-
though they operate on the fanguife.ro.us, yet, ifrgiven
in frequently repeated fmall rather than in large dofes,
their operation being tranfitory, is tolerably fare.

2. The vegetables of the clafs named Tetradyna?
niia, are many of them powerful diifufive flimulants ;
and at the fame time, as quickly palling out of the bo-
dy, and therefore of tranlitory operation, they are of-
ten employed with fafetyf . As they commonly prove
diuretic, they may in this way alfo Up of fervice in
fome cafes of ferous palfy.

N 2 3. The

* Of tliefe there are feveral formulae in the (hops, as, Spiritus vo-
latilis aromaticus, Spiritus volatilis oleofus, Spiritus falinus aromati-
cus. Their dofe is from ten to fixty drops. The Eau de Luce
ought to be mentioned here, though it isfeldom ufed internally, hut
only for fmelling to, as it is extremely penetrating. It is prepared
thus : mix together in a retort forty drops of reified oil of amher,
an ounce of reftified fpirit of wine, and twelve ounces of the ftrong-
eft cauftic volatile alkali. Theymuft be diililled with a very mode-
rate fire. It is feldom limpid, but has a milky appearance, owing to
the imperfec"l folution of the oil in the fpirit ; and, if the alkali be
not very cauitic, fcarcely any of the oil is diffolved.

f White muftard-feeds may be given whole, in the quantity of two
tea-fpoonfuls in half a tea-cupful of cold water. They ought to be
fwallowcd whole, that their acrid tafte may not be perceived. The
dofe may be repeated twice or thrice a-day. -Horfe-radifh is another
piant of this clafs of vegetables, that has been much recommended ;
it mufi be given in a cold watery infufion, or in an in.fwfion of ale.

ioo PRACTICE

3. The various aromatics, whether employed in
fubftance, in tincture, or in their effential oils, are of. *
ten powerful ftimulants ; but being more adheilve and
inflammatory than thofe laft mentioned, they are
therefore, in all ambiguous cafes, lefs fafe*.

4. Some other acrid vegetables have been employ-
ed ; but we are not well acquainted with their peculiar
virtues, or proper life.

g. Some reiinous fubitances, as guaiacum, and the
terebinthinate fubflanccs, or their effential oils, have
been, with fome probability, employed ; but they are
apt to become inflammatory. Deceptions of guaia-
cum, and fome other fudorifics, have been directed to
excite fweating by the application of the fumes of
burning fpirit of wine in the laconicum, and have in
that way been found ufeful.

6. Many of thefetid antifpafmodic medicines have
been frequently employed in palfy ; but I do not per-
ceive in what manner they are adapted to the cure
of this difede, 'and I have not obferved their good ef-
fects in any cafes of it.

7. Bitters, and the Peruvian bark, have alfo been
employed ; but with no propriety or advantage that I
can perceivef .

MCLXX.

The fcurvy^grafs is another of the fame clafs ; it may be eaten raw,
or we may give foi ty or fifty drops of the Spit Jtus cochleariae, either
on a piece of fugar, or mixed with half an ounce of fyrup, four or
five times a-day. Tin's fpirit ought to be kept well corked, as it
foon lofes its activity, if it be expofed to the air.

* The aromatics beil adapted for ftimulating, in thefe cafes, are
fuch as Linne calls fpirantia ; the chief of them are Marum, Rofema-
ry, Lavender, &c. Their fpiritous waters are much more effica-
cious than the plants in fubflance, or in any other form ; and their
efficacy is confiderably increafed by uniting them to volatile fpirits,
as in fome of the formulae mentioned in the note on par. 1 169, 1. 6,
at the word fyftem.

f In fome cafes, paralytic patients, for want of exercife, fink in-
to a ft ate of debility, with lofs of appetite, and confequent emacia-

O F P H Y S I C. 10?

MCLXX.

With refpeft to the whole of thefe internal flimu-
lants, it is to be obferved, that they ieklom prore very
powerful 5 and wherever there is any doubt concern-
ing the nature or ft ate of the difeafo, they may readi-
ly do harm, and are often therefore of ambiguous ufe.

BOOK II.

OF A D Y N A'M I JE ;

O R.

DISEASES CONSISTING IN A WEAKNESS OR

LOSS OF MOTION IN EITHER THE VITAL

OR NATURAL FUNCTIONS.

CHAP. I,

OF SYNCOPE OR FAINTING.

MCLXXI.

THIS is a difeafe in which the action of the heart
and refpiration become confiderably weaker
than ufual, or in which for a certain time thefe func-
tions ceafe altogether.

MCLXXII.

Phyiicians having obferved that this afFeclion oc-
curs in different degrees, have endeavoured to diftin-
guifh thefe by different appellations : but as it is not
poffible to afcertain thefe different degrees with any

preciiion,

tion, In which bitter*, penman bark, and other tonics, are frequently
of fome advantage,

io2 PRACTICE

precifion, fo there can be no,ftric~i propriety in em-
ploying thofe different names ; and I {hall here com-
prehend the whole of the affedions of this kind un-
der the title of Syncope.

MCLXXIII.

This difeafe fometimes comes on fuddenly to a con-
fiderable degree, but fometimes alfo it comes on gra-
dually; and in the latter cafe, it ufually comes on
with a fenfe of langour, and of anxiety about the
heart, accompanied at the fame time, or immediately
after, with fome giddinefs, dimnefs of fight, and found-
ing in the ears. Together with thefe fymptoms, the
pulfe and refpiration become weak ; and often fo weak,
that the pulfe is fcarccly to be felt, or the 'refpiration
to be perceived ; and fometimes thefe motions, for a
certain time, ceafe altogether. While thefe fymp-
toms take place, the face and whole fuiface of the bo-
dy become pale, and more or lefs cold according to
the degree and duration of the paroxyfm. X^ery
commonly, at the beginning of this, and during its
continuance, a cold fweat appears, and perhaps conti-
nues, on the fore-head, as well as on fome other parts
of the body. During the paroxyfms, the animal
functions, both of fenfe and motion, are always in fome
degree impaired, and very often entirely fufpendcd.
A paroxyiVn of fyncope is often, after fome time, fpon-
taneoufly recovered from ; and this recovery is gene-
rally attended with a fenfe of much anxiety about the
heart.

Fits of fyncope are frequently attended with, or end
in, vomiting ; and fometimes with convulfions, or an
epileptic fit.

MCLXXIV.

Thefe are the phenomena in this difeafe ; and from
every view of the greateflparc of them, there cannot
be a' doubt that the proximate caufe of this difeafe is
a very weak or a total ceaiing of the adion of the

heart.

o F p n Y s r a io3

heart. But it will be a very difficult matter to explain
in what manner the fevcral remote caufes operate in
producing the proximate caufe. This, however, I
ihail attempt, though with that diffidence which be-
comes me in attempting a fubject that has not hither-
to been treated with much fuccefs.
MCLXXIVf.

The remote caufe of fyncope may, in the firft place,
be referred to two general heads. The one is, of
thofe caufes 'exifting and acting in the brain, or in
parts of the body remote from the heart, but acting
upon it. by the intervention of the brain. The other
general head of the remote caufes of fyncope, is of
thofe exilting in the heart itfelf, or in parts very im-
mediately connected with it, and thereby acting more
directly upon it in producing this difeafe.
MCLXXV,

In entering upon the coniideration of the firfl fet of
thofe caufes (MCLXXIV.), I muft affume a proportion
which I fuppofe to be fully eftablimed in phyfiology.
It is this : That, though the mufcular fibres of the
heart be endowed with a certain degree of inherent
power, they are dill, for fuch action as is necefiary to
the motion of the blood, very conftantly dependent
upon a nervous power fent into them from the brain J.
At leaft this is evident, that there are certain powers
acting primarily, and perhaps only in the brain, which
influence and variouily modify the action of the heart.

I

•f The Paragraphs were thus numbered in the laft edition.

$ The author here differs fomewhat in opinion from other phyfic-
logifts. He allows, indeed, that the heart poffeifes a vis infita in a
certain degree, ; but he will not allow this vis infita to be fuffieient-
ly rtrong for carrying on the circulation ; and he thinks that fome
energy mud be imparted to the heart from the brain, in order to en-
able that important mufcle feo perform its office.

In fupport of this opinion, we have a plain fa£t, which the author
might have adduced, viz. that a ligature on the nerves going to the
keart immediately Hops its motions.

io4 PRACTICE

I fuppofe, therefore, a force very conftantly during
life exerted in the brain, with refpect to the moving
fibres of the he ut, as well as of every part of the body ;
which fbrce I fhall call the energy of the brain ; and
which I fuppofe may be, on different occafions, ilrong-
er or weaker with reipecl to the heart.

MCLXXVI.

Admitting thefe proportions, it will be obvious,
that if I can explain in what manner the firft fet of
remote caufes (MCLXXIV.) diminifh the energy of the
brain, I ihall at the fame time explain in what manner
thefc caufes occaiion a fvncope.

MCLXXVII.

To do this, I obferve, that one of the moil evident
of the remote caufes of fyncope is a hemorrhagy, or
an evacuation of blood, whether fpontaneous or artifi-
ciai. And as it is very manifeft that the energy of
the brain depends upon a certain fulnefs and tenflon
of its blood-veffels, for which nature feems to have in-
duftriouily provided by fuch a conformation of thofe
blood-veiFels as retards the motion of the blood both
in the arteries and veins of the brain ; fo we can rea-
dily perceive, that evacuations of blood, by taking off
the fullnefs and tcnfion of the blood-verTels of the
brain, and thereby diminifhing its energy with refpect
to the heart, rmy occaiion a iyncope. In many per-
fons a fmall evacuation of blood will have this effect ;
and in fuch cafes there is often a clear proof of the
manner in which the caufe operates, from this circum-
ftance, that the effect can be prevented by laying the
body in a horizontal pofturc ; which, by favouring the
afflux of the blood by the arteries, and retarding the
return of it by the veins, preferves the neceflary ful-
nefs of the veflels of the brain.

It is farther to be remarked here, that not only an
evacuation of blood occafions fyncope, but that even a
change in the diftribution of the blood, whereby a

larger

OF PHYSIC. 105

larger portion of it flows into one part of the fyftem
of blood-veffels, and confequently lefs into others,
may occafion a fyncope. It is thus I explain the fyn-
cope that readily occurs upon the evacuation of hy-
dropic waters, which had before filled the cavities of
the abdomen or thorax. It is thus alfo I explain the
fyncope that fometimes happens on blood-letting, but
which does not happen till the ligature which had been
employed is united, arid admits a larger afHux of blood
into the blood-veffels of the arm. Both thcfe cafes of
fyncope ihovv, that :m evacuation of blood does not
always occafion the difcafe by any general effect on
the whole fyftem, but often merely by taking off the
requifite fuinefs of the blood -veffcls of the brain.

MCL xxviii.

The operation of fome others of the remote caufes
of fyncope, may be explained on the following princi-
ples. Whilft the energy of the brain is, upon differ-
ent occaiions, nianifeftly flronger or weaker, it feems
to be with this condition, that a flronger exertion of it is
neceffarily followed byaweakerflateof the fame, it feems
to depend upon this law in the conilitution of the ner-
vous power, that the ordinary contraction of a mufclc
is always alternated with a relaxation of the fame ;
that, unlefs a contraction proceeds to the degree of-
fpafm, the contracted flate cannot be long continued ;
and it feems to depend upon the fame caufe that the
voluntary motions, which always require an unufual
increafe of exertion, and occafion fatigue, debility, and
at length irrefiftible fleep.

From this law, therefore, of the nervous power, we
may underfland why a fudden and violent exertion
of the energy of the brain is fometimes followed by
ftich a diminution of it as to occafion a fyncope-; and
it is thus I fuppofe that a violent fit of joy produces
fyncope, and even death. It is upon the fame princi-
ple alfo, I fuppofe, that an exquifite pain may fome-
times excite the energy of the brain more ftrongly

VOL. II. O than

106 PRACTICE

than can be fupported, and is therefore followed by
fuch a diminution as mud occafion fainting. But
the effecl: of this principle appears more clearly in
this, that a fainting readily happens upon the fuclden
remiflion of a confiderable pain ; and thus I have feen
a fainting occur upon the reduction of a painful diflo-
cation.

MCLXXIX.

It feems to be quite analogous when a fyncope im-.
mediately happens on the finifhing of any great and
long-continued effort, whether depending on the will,
or upon a propenfity ; arid in this way a fainting
fometimes happens to a woman on the bearing of a
child. This may be well illuftrated by obferving, that
in perfons already much weakened, even a very mode-
rate effort will fometimes occafion fainting.
MCLXXX.

To explain the operation of fome other caufes of
fyncope, it may be oblerved, that as the exertions of
the energy of the brain are efpecially under the influ-
ence of the will, fo it is well known that thofe modifi-
cations of the will which are named Pailions and Emo-
tions, have a powerful influence on the energy of the
brain in its acHons upon the heart, either in increafing
or diminiming the force of that energy. Thus, anger
has the former, and fear the latter effect, ; and thence'
it may be underilood how terror often occafions a fyn-
cope fometimes of the moft violent kind, named Af-
phyxia, and fometimes death itfeJf.
MCLXXXL

As, from what I have j oft mentioned, it appears,
that the emotions of defire increafe, and thofe of aver-
fion diminifh, the energy of the brain ; fo it may be
undeaiood, how a ftrong averfion, a horror, or the
feeling which arifes upon the light of a very difagreea-
•ble object, may occafion fainting. As an example of
this, I have known more than one inftance of a perfon's
fainting at the fight of a fore in another perfon.

MCLXXXIL

OF PHY SI C. 107

MCLXXXII.

To this head of horror and difgiifi:, I refer the ope-
ration of thofe odours which in certain perfons occa-
lion fyncope. It may be i'upp ofcd, that thofe odours
are endowed with a directly iedative power, and. may
thereby occafion fyncope; but they are, many of them,
with refpect to adher perlbns, evidently of a contrary
quality; audit apprars to nifc, <ie odours occa-

lion fyncope only in thofe pedbas to whom they are
extremely disagreeable.

MCLXXXIIL

It is, however, very probable, that among the cauf-
;cs of fyncope, there are f -me which, analogous to all
thofe we have already mentioned, act by a directly fe-
dative power: ar.d fuch may either be ditfufed in the
mafs of bipod, and thereby communicated to the
brain; or may be only taken into the ftomach, which
fo readily and frequently communicates its affections
to the brain.

MGLXXXIV.

Having now enumerated, and, as I hope, explained,
the molt part of the remote caufes of fyncope, that
cither o'perate immediately upon the brain, or whofe
operation upon other parts of the body is communi-
cated to the brain, it is proper to obferve, that the
mod part of thefe caufes operate upon certain perfons
more readily and more powerfully than upon others 5
and this circumitance, which may be confidered as the
predifponent caufp of fyncope, defc^es to be inquired
into.

It is, in the firfl place, obvious, that the operation
of fome of thofe caufes depends entirely upon an idio-
fyncrafy in the perfons upon whom they operate ;
which, however, I cannot pretend to explain. But,
in the next place, with rcfpect to the greater part of
the other caufes, their effects feern to depend upon a
temperament which is in one degree or other in com-

O 2 mon

io8 PRACTICE

mon to many perfons. This temperament feenis to
confift in a great degree of fenfibility and mobility,
arifing from a flate of debility, ibmetLues depending
upon original conformation, and fometimes produced
by accidental occurrences in the courfe of
MCLXXXV.

The fecond fet of the remote caufes of fyncope
(MCLXXIV.), or th >fe acting directly upon the heart
itfelf, are certain organic affections of the heart itfelf,
or of the parts immediately connected with it, parti-
cularly the great veflels which pour blood into or
immediately receive it from the cavities, of the heart.
Thus a dilatation or aneurifm of the heart, a polypus
in its cavities, abfceiTes or ulcerations in its fubftance,
a clofe adherence of the pericardium to the furface of
the heart, aneurifms of the great veflels near to the
heart, polypus in thefe j and offiflcations in thefe or in
the valves of the heart, are one or other of them condi-
tions which, upon diffecTiion, have been difcovered in.
thofe perfons who had before laboured under frequent
fyncope.

MCLXXXVI.

It is obvious, that thefe conditions are all of them,
either fuch as may, upon occafion, diflurb the free and
regular influx into, or the free egrefs of the blood
from, the cavities of the heart; or fuch as may other-
wife diflurb its regular action, by fometimes interrupt-
ing it, or fometimes exciting it to more violent and
convulfive action.® The latter is what is named the
Palpitation of the Heart, and it commonly occurs in
the fame perfons who are liable to fyncope.
MCLXXXVIL

It is this, as I judge, that leads us to perceive in
what manner thefe organic affections of the heart and
great veflels may occafion fyncope : for it may be
fuppofed, that the violent exertions made in palpita-
tions may either give occafion to an alternate great

relax-

O F P H Y S I C. 109

relaxation, (MCLXXVX i :.) or to a fpafrnodic contrac-
tion ; and in either way fuipend the action of the
heart, and occafion Tyncope. It fcems to me probable,
that it is a fpafmodic contraction of the heart that oc-
cafions the intermiflion of the pulfe fo frequently ac-
companying palpitation and fyncope.
MCLXXXVIil.

Though it frequently happens that palpitation and
fyncope arife, as we have faicl, from the organic affec-
tions above mentioned, it is proper to cbferve, that
difeafes, even when in a Violent degree, do not always
depend on fuch caufes acting directly on the heart,
but' are o;ten depend'enc on fonie of thofe caufes
which we have mentioned above as acting primarily
on the brain.

MCLXXXIX.

I have thus endeavoured to give the pathology of
fyncope ; and of the cure I can treat very fhortly.

The cafes of fyncope depending on the fecond fet
of caufes, (MCLXXIV.) and fully recited in MCLXXXV.
I fuppofe to be generally incurable ; as our art, fo far
asl know, has not yet taught us to cure any of thofe
feveral caufes of fyncope (MCLXXXV.)

The cafes of fyncope depending on the firft fet of
caufes. (MCLXXIV.) and whole operation I have endea-
voured to explain in MCLXXVII. et feq. I hold to be
generally curable, either by avoiding the feveral occa-
iional caufes there pointed out, or by correcting the
predifponent caufes (MCLXXXIV.) The latter, I think,
may generally be done by correcting the debility or
mobility of the fyftem, by the means which I have al-
ready had occafion to point out in another place*.

CHAP.

* See Aiticle 217, &c.

io PRACTICE

C H A P. II.
OF DYSPEPSIA, OR INDIGESTION.

MCXC,

A WANT of appetite, a fqueamimnefs, fometimes
a vomiting, fudden andtrarilientdiftentionsof the
ilomachjeruclations of various kinds, heartburns, pains
inthereg-ons of the ftomach, and a bound belly, are fymp-
toffis which frequently concur in the fame perfon, and
therefore may be prefumed to depend upon one and
the fame proximate caufe. In both views, therefore^
they may be coniidered as forming one and the fame
difeafe, to which we have given the appellation of
Dyfpepjia? fct at the head of this chapter.

MCXCL

But as this difeafe is alfo frequently a fecondary and
fympathic afiecxion,ib thefyrnpioms above-mentioned
are often joined with many others ; and this has given
occalion to a very confufed and undetermined defcrip-
tion of it, under the general title of Nervous Difeafes,
or under that of Chronic Weaknefs. It is proper,
however, to diftinguifti ; and I apprehend the fymp?
toms enumerated above are thofe effential to the idio-
pathic affection I am now to treat of.
MCXCII.

It is indeed to be particularly obferved, that thefe
fymptorns are often truly accompanied with a certain
ftate of mind which may be confidered as a part of
the idiopathic affection: but I lhall take no further
notice of this fymptom in the prefent chapter, as it
will be fully and more properly confidered in the next,
under the tide of Hypochondriacs.
MCXCIII.

That there is a difliacl difeafe attended always with

a greater

OF PHYSIC. lit

a greater part of the above fymptoms, Is rendered
very probable by this, that all theie feveral fymp-
toms may arife from one and the fame caufe; that is7
from an imbecility, lofs of tone, and weaker action in
the mufcular fibres of the ftomach : and I conclude
therefore, that this imbecility may be coniidered as the
proximate caufe of the difeafe I am to treat of under
the name of Dyfpepfia.

MCXCIV.

The imbecility of the ftomach, and the confequent
fymptoms (MCXC.) may, however, frequently depend
upon fome organic affection of the ftomach itfelf, as
tumour, ulcer, or fcirrhofity ; or upon fome arFeftion
of other parts of the body communicated to the fto-'
mach, as in gout, amenorrhcea, and fome others. In
all thefe cafes, however, the dyfpeptic fymptoms are
to be coniidered as fecondary or fympathic affections ,.
to be cured only by curing the primary difeafe. —
Such fecondary and fympathic cafes cannot, indeed,
be treated or here; but as I prefume that the imbeci-
lity of the ftomach may often take place without»ei-
ther any organic affedion of this part, or any more
primary affection in any other part of the body ; fo I
fuppoie and expecl it will appear, from the confedera-
tion of the remote caufes, that the dyfpepfia may be
often an idiopathic affection, and that iris therefore
properly taken into the fyftem of methodical Ncfology,
and becomes the fubjeft of our conlideration here.
MCXCV.

There can be little doubt, that in moft cafes, the
weaker action of the mufcular fibres of the ftomach,
is the moft frequent and chief eaufe of the fymptoms
mentioned in MCXC. ; but I dare not maintain it to be
the only caufe of idiopathic dyfpepfia. There isr
pretty certainly, a peculiar fluid in the ftomach of ani-
mals, or at leaft a peculiar quality in the fluids, that
we know to be there, upon which th^folution of the

all-

ii2 PRACTICE

aliments taken into the ftomach chiefly depends : and
i; is at the Dime time probable, that the peculiar quali-
ty of the diflblving or digefting fluids may be variouf-
iy changed, or that their quantity may be, upon occa-
fion, diminifhed. It is therefore ftifficiently probable,
that a change in the quality or quantity of thefe tiuids
may produce a coniiderable difference in the pheno-
mena of digeftipn, and particularly may give occafion
to many of the morbid appearances mentioned in
MCXC.

MCXCVL

This feems to be very well founded, and points out
another proximate caufe of dyfpepfia befide that we
have already afiigned : But, notwithstanding this, as
the peculiar nature of the digeftive fluid, the changes
which it mayv undergo, or thecaufes by which it may
be changed, are ail matters fo little known, that I can-
not found any practical doctrine upon any fuppofition
with refpect to them ; and as, at the fame time, the im-
becility of the ftomach, either as caufing the change in
the digeftive fluid, or as being induced by that change,
feems always to be preient, and to have a great mare in
occafioning thefymptoms of indigeftion; fo I fhall ftill
coniider the imbecility of the ftomach as the proximate
and almofl fole caufe of dyfpepiia. And I more rea-
dily admit of this manner of proceeding ; as, in my
opinion, the doctrine applies very fully and clearly to
the explaining the whole of the practice which expe-
rience has eftablifhed as the moft fuccefsful in this
difeafe.

MCXCVII.

Considering this, then, as the proximate caufe of
dyfpepfia, I proceed to mention the feveral remote
caufesof this difeafe ; as they are fuch, as, on differ-
ent occafions, feem to produce a lois of tone in the
mufcular fibres of the ftomach. They may, I think,
be confidered under two heads. The jfr/2 is, of thofe

which

O F P H T S I C. 113

•which a& directly and immediately upon the flomach
itfelf: The fecond is, of thofe which act upon the
whole body, or particular parts of it, but in confe-
quence of "which the flomach is chiefly or almofl only
affected.

MGXCVIII.
Ofthefirftkindarc,

1. Certain fedative or narcotic fufoftances taken
into the flomach ; fuch as tea, coflee, tobacco, ar-
dent fpirits, opium, bitters, aromatics, putrids, and
acefcents.

2. The large and frequent drinking of warm water,
or of warm watery liquids.

3. Frequent forfeit, or immoderate repletion of the
flomach.

4. Frequent vomiting whether fpontaneoufly arif-
ing, or excited by art.

5. Very frequent fpitting, or rejection of faliva.

MCXCIX. *

Thofe caufes which act upon the \vhole body, or
upon particular parts and functions of it, are,

1. An indolent and fedentary life.

2. Vexation of mind, and diforderly paflions of anv
kind.

3. Intenfe fludy, or clofe application to bufincfs
too long continued.

4. Excefs in venery.

5. Frequent intoxication ; which partly belongs to
this head, partly to the former.

6. The being much expofed to moid and cold air
Vvhen without exercife.

MCC.

Though the difeafe, as proceeding from the laft fet
of caufes, may be coniidered as a fymptomatic affec-
tion only ; yet as the affection of the flomach is gene-
rally the firft, always the chief, and often the only ef-
fect which thefe caufes produce or difcovcr, I think
the affection of the ftomach may be confidered as the

VOL, II. P difeafe

PRACTICE

difeafe to be attended to in practice ; and the more
properly fo, as in many cafes the general debility is
only to be cured by reftoring the tone of the ftomach,
and by remedies firft applied ro this organ.

MCCI.

For the cure of this difeafe, we form three feveral
indications ; a prefervative, a palliative, and a curative.

Thejir/l is, to avoid or remove the remote caufes
juft now enumerated.

The fccond is, to remove thofe fyrnptoms which
efpecially contribute to aggravate and continue the
difeafe. And,

The third is, to reftore the tone of the ftomach ;
that is, to correct or remove the proximate caufe of
the difeafe.

MCCIL

The propriety and neceffity of the firft indication
is fufficiently evident, as the continued application,
or frequent repetition of thofe caufes, muft continue
the difeafe ; may defeat the ufe of the remedies ; or,
in fpite of thefe, may occallon the recurrence of the
difeafe. It is commonly the neglecl of this indication
which renders this difeafe fo frequently obftinate. —
How the indication is to be executed, will be fuffici-
emly obvious from the confideration of the feveral
caufes : but it is proper for the practitioner to attend
to this, that the execution is often exceedingly diffi-
cult, becaufe it is not eaiy to engage men to break in
upon eftablimed habits, or to renounce the purfuit of
pleafure ; and particularly, to perfuade men that thefe
practices are truly hurtful which they have often
practifed with feeming impunity.

MCCIII.

The fymptoms of this difeafe which efpecially con-
tribute to aggravate and continue it, and therefore
require to be more immediately corrected or removed,
are, firft, the crudities of the itornach already produc-
ed

OF PHYSIC. 115

cd by the difeafe, and difcovered by a lofs of appetite,
by a fenfe of weight and uneaiinefs in the ftomach, and
particularly by the eructation of imperfectly digefted
matters.

Another fymptom to be immediately corrected, is
an unufual quantity, or a higher degree than ufual, of
acidity prefent in the ftomach, difcovered by various
diforders in digeftion, and by other effects to be menti-
oned afterwards.

The third fymptom aggravating the difeafe, and
otherwife in itfelf urgent, is coitiveuefs, and therefore
conftantly requiring to be relieved.

Mcciy.

Thejir/l of thefe fymptoms is to be relieved by ex
citing vomiting ; and theuie of this remedy, therefore,
ufually and properly begins the cure of this difeafe.
The vomiting may be excited by various means, more
gentle or more violent. The former may anfwer the
purpofe of evacuating the contents of the ftomach :
but emetics, and vomiting, may alfo excite the ordi-
nary action of the ftomach j and both, by variouily
agitating the fyftern, and particularly by determining
to the furface of the body, may contribute to remove
the caufes of the difeafe. But thefe latter effects can
only be obtained by the ufe of emetics of the more
powerful kind, fuch as the antimonial emetics efpeci-
ally are*.

MGCV.

The fecond fymptom to be palliated^ is an excefs of
acidity, either in quantity or quality, in the contents
of the ftomach. In man there is a quantity of acefcent
aliments almofl commonly taken in, and, as I think,
always undergoes an acetous fermentation in the fto-
mach y and it is therefore that, in the human ftomach,

P 2 and

* The formulae and dofes of antimonial emetics have been deferib-
ed in a note on Article 185.

n6 FRAG T I C E

and in the ilomachs of all animals ufmg vegetable
food, there is always found an acid prefent. The a-
cid, however, is generally innocent, and occaiions no
diforder, unlefs either the quantity of it is large, or the
acidity proceeds to a higher degree than ufual. But,
in either of thefe cafes, the acid occafions various dif-
orders, as flatulency, eructation, heartburn, gnawing
pains of the Itomach, irregular appetites and cravings,
loofenefs, griping, emaciation, and debility. To ob-
viate or remove thefe effects aggravating and continu-
ing the dileafe, it is not only necefTary to correct the
acid prefent in the iiomach ; but, efpecially as this a-
cid proves a ferment determining and increafing the
acefcency of the aliments afterwards taken in, it is pro-
per alfo, as foon as poilible, to correct the difpofuion
to exceffive acidity.

MCCVI.

The acidity prefent in the ffeomach may be correct-
ed by the ufe of alkaline falls, or abforbent earths* ;

or

* No part of the practice of phyfic requires more caution than
th'e adminiilering alkaline falls, and abforbent earths. The alkaline
falts, by their Cciuitis quality, corrode the ftomach, and blunt its ac-
tion, when taken in too large .quantities ; and efpecially if, from a
iniftaken diaguofis, no acid is in the ftomach.

Lime-water is certainly preferable to the alkaline falts ; its dofe
may vary from two to four ounces twice a-cny, according to the ur-
gency of the cafe.

The abforbent earths, as chalk, crabs eyes, Sfc. if they do not
meet with an acid, are apt to concrete into a hard indiiToluble mafs,
by the mucus of the ftomaeh.

Magnefia is doubtlefs, in many cafes, preferable to the calcareous
earth ; when, ou account qf its purgative quality, we cannot conti-
nue its ufe. Chalk is preferable to the teiiaceous powders, tecaufe
it is free from that glutinous fubftauce with which teltaceous powders
abound, and which the more readily difpofes them to concrete in the
ftomach. The dofe of magnefia is from 3i. to ^i. twice or thrice
a-day ; and its purgative quality raay, in many cafes, be prevented,
by adding to each dofe of it ten or fifteen grains of rhubarb, and li.-c
or fix drops of oil of ahife-fced.

O F P H Y S I C. 117

or by fuch fubftances, containing thefe, as can be de-
compofed by the acid of the iloraach. Of the alka-
lines, the cauftic is more effectual than the mild ; and
this accounts for the effects of lime-water. By em-
ploying abforbents, we avoid the excels of alkali,
which might fometimes take place. The abforbents
are different, as they form a neutral more or lefs laxa-
tive ; and hence the difference between magnefia alba
and other abforbents. It is to be obferved, that alka-
lines and abforbents may be employed to excefs ; as
when employed in large quantity, they may deprive
the animal fluids of the acid neceffary to their proper
cornpolition.

MCCVII.

The difpofition to acidity may be obviated by a-
voiding acefcent aliments, and uiing animal-food little
capable of acefcency. This, however, cannot be long
continued without corrupting the ftate of our blood ;
and as vegetable food cannot be entirely avoided, the
excefs of their acefcency may in fome meafure be a-
voided, by choofmg vegetable food the leaft difpofed
to a vinous fermentation, fuch as leavened bread and
\vell fermented liquors, and, inflead of frefli native
acids, employing vinegar.

MCCVIII.

The acid arifing from acefcent matters in a found
ftate of the (lomach, does not proceed to any high de-
gree, or is again icon involved and made to difappear :

but

The Deco£tum cretaceum of the Edinburgh Pharmacopoeia is a
good form for the exhibition of chalk. But chalk ir, ay be given
with rhubarb and oil of anifc- feeds, like magnefja. The Trochitci
c creta is a convenient form for giving the chalk, had the crabs eyes
been omitted. The following antacid troches are both effectual and
pleafant :

&. Magnef. alb- vi.

Sacch. alb. 511*'.

Nuc. mofch. 3ii.

JV1. f. trochifci cu:n mucilagtn. gum tragacaath. q. i*.

uS PRACTICE

but .this does not always happen ; and a more copious
acidity, or a higher degree of it, may be produced,
either from a change in the digeflive fluids, become
lefs fit to moderate fermentation an4 to cover acidi-
ty, or from their not being fupplied in due quantity.
How the former may be occasioned, we do not well
underfland ; but we can readjly perceive that the lat-
ter, perhaps the former alfo, may proceed from a
weaker action of the mufcular fibres of the flomach.
In certain cafes, fedative paffions, immediately after
they arife, occaflon the appearance of acidity in the
flomach which did not appear before ; and the ufe of
flimulants often corrects or obviates an acidity that
would otherwife have appeared. Frcm thefe con-
fiderations, we conclude, that the production and fub-
fiftence of acidity in the flomach, is to be efpecial-
ly prevented by refloring and exciting the proper ac-
tion of it, by the feveral means to be mentioned here-
after.

MCCIX.

But it is alfo to be further obferved, that though
there are certain powers in the flomach for preventing
a too copious acidity, or a high degree of it, they are
riot however alwajs fuflicient for preventing aceicen-
cy, or for covering the acidity produced; and there-
fore, as long as vegetable fubflances remain in the flo-
mach, their acefcency may go on and increafe. From
hence we perceive, that a fpecial caufe of the excefs
of acidity may be, the too long retention of the acef-
ccnt matters in the flomach ; whether this may be
from thefe matters being of more difficult folution, or
from the weaknefs of the ilomach more flowly dif-
charging its contents into the duodenum, orfromfome
impediment to the free evacuation of the flomach by
the pylorus. The latter of thefe caufes we are well
acquainted with, in the cafe of a fcirrhous pylorus,
producing commonly the higheft degree of acidity.

la

OFPHYSIC. 119

In all the inftances of this fcirrhoiity I have met with,
I have found it incurable : but the firft of thefe caufes
is to be obviated by avoiding fuch aliments as are of
difficult folution ; and thefecond is to be mended by the
fcveral remedies for exciting the action of the ftomach,
to be mentioned afterwards.

MCCX.

The third fympiom commonly accompanying dyf-
pepfia, which requires to be immediately removed, is
coftivenefs. There is fo much connection between,
the feveiai portions of the alimentary canal with re-
fpect to the periftaltic motion, that, if accelerated or
retarded in any one part, the other parts of it are
commonly affected in the fame manner. Thus, as the
brilker action of the ftomach muft accelerate the acti-
on of the inteftines, fo the flower action of the intef-
tines muft in fome meafure retard that of the fto-
mach. It is therefore of ccnfequence to the proper
action of the ftomach, that the periftaitic motion of
the interlines determining their contents downwards,
be regularly continued ; and that all coftivenefs, or
interruption of that determination, be avoided. This
may be done by the various means of exciting the
action of the inteftines : but it is to be obferved here,
that as every confiderable evacuation of the interlines
weakens their action, and is ready therefore to induce
coftivenefs when the evacuation is over ; fo thofe pur-
gatives which produce alarge evacuation, are unfit for
correcting the habit of coftivenefs. This, therefore,
Ihould be attempted by medicines, which do no more
than folicit the inteftines to a more ready difcharge of
their prefent contents, without either hurrying their
action, or increasing the excretions made into their
cavity : either of which effects might produce a purg-
ing. There are, I think, certain medicines peculiarly
proper on this occafion, as they feem to ftimulate efpe-

ciaily

i2o P R A C T I G E

cially the great guts, and to act little on the higher
parts of the inteftinal canal*.

MCCXI.

We have thus mentioned the feveral means of exe-
cuting our fecond indication ; and I proceed to the
third) which is, as we have {aid, the proper curative ;
and it is to reftore the tone of the fiomach, the lofs of
which we confided as the proximate caufe of the dif-
eafe, or at leaft as the chief part of it. The means of
fatisfying this indication we refer to two heads. One
is, of thofe means which operate directly and chiefly
on the ilomach itfelf ; and the other is, of thofe means
which, operating upon the whole fyfteni, have their
tonic effects thereby communicated to the flomach.
MCCX1I,

The medicines, which operate directly on the flo-
mach , are either ilimulants or tonics.

The ilimulants are faline or aromatic.

The faline are acids or neutrals.

Acids of all kinds fee m to have the power of flimu-
lating the ftomach, and therefore often increafe appe-
tite : but the native acids, as liable to fermentation,
may other-wife do harm, and arc therefore of ambigu-
ous ufc. The acids, therefore, chiefly and fuccefs ful-
ly employed, are the vitriolic§, muriaticf, and the dif-
tilled acid of vegetables, as it is found in tar water,
which are all of them aritizymicsf.

The

'* Ten or fifteen grains of Pil. Ruf. anfwer this purpofe fufficiently
well. It is to be regretted tijat the Author did not mention thofe
certain medicines to which he alludes.

§ The dofe of the vitriolic acid ought not to exceed ten drops,
and it fhould be well diluted with water.

•f- The Tin6lura Martis of the Edinburgh College powerfully fti-
mukites the ilomach, and a 61s at the fame time as a tonic ; its dofe
is from ten to twenty drops thrice a-day, in a fufficient quantity of
any proper liquid, and it is a very agreeable medicine,
I. e. refill fermentation.

O V P H Y S I C. 121

The neutral falts anfwering this- intention, are efpe-
cially thofe which have the muriatic acid in their
competition, though it is prefumed that neutrals of
all kinds have more or lefs of the fame virtue*.

MCCXIII.

The aromatics, and perhaps fome other acrids, cer-
tainly ftimulate the ftomach, as they obviate the acef-
cenc) a:id flarulency of vegetable food : but their fti~
mulus is naufitory; and if frequently repeated, and
taken in large qaantiiies, they may hurt the tone of
the ftomachj- .

MCCXIV.

The tonics employed to ftrengthen the ftomach are
bitters, bitteis and aftringents combined, and chaly-
beaces.

Bitters are undoubtedly tonic medicines, both with
refpecl to the ftomach and the whole fyftem : but
their long-continued ufe has been found to deftroy
the tone of the ftomach and of the \vhole fyftem ; and
wnether this is from the mere repetition of their to-
nic operation, or from fome narcotic power joined
with the tonic in them, I am uncertain.

MCCXV.

Bitters and aftringents combined, are, probably,

more effectual tonics than either of them taken {in-

gly ; and we fuppofefuch a combination to take place,

in the Peruvian bark ; which therefore proves a pow-

VOL. II. Q^ . erful

* The Sal digeftims, i. c. the muriatic acid faturated with rege-
table fixed alkali, was thought to be preferable to common fait in
promoting digeftion, Hence its old name of Sal digeilivus. Its
fuperiority over common fait is however doubtful,

f This caution agaiutt the too free ufc of aromatics ought to be
peculiarly attended to by the young practitioner. The fpeedy re*
lief which they procure tempts the patient to have frequent recourfe
to them, which, as the Author juftly obferves, may materially hurt
the tone of the ftomach, and confequently increafe the difeafe whick
they were intended to remove.

122 PRACTICE

erful tonic, both with refpccl to the flomach and to
the whole fyitern. But I have fome ground to fuf-
pe&, that the long-continued ufe of this bark may,
like bitters, deftroy both the tone of the flomach and
of the whole fy ft t m * .

MCCXVI.

Chalybcates may be employed as tonics in various
forms-]*, and in considerable quantities, with fafety.
They have been often employed in the form of mine-
ral waters, and feemingly with iuccefs : but whether
this is owing to the chalybeate in the compofvtion
of thefe waters, or to forne other circumftances at-
tending their ufe, I dare not politively determine j
but the latter opinion feems to rne the more probable.

MCCXV1I.

The remedies which ilrengthcn the ftomach, by be-
ing applied to the whole body, are, exercife and the
application of cold.

As exercife ftrengthens the whole body, it muft al-
fo ftrengthen the ftomach ; but it does this alfo in a
particular manner, by promoting perfpiration, and
exciting the aftion of the veffels on the furface of the
body, which have a particular confent with the muf-
cular fibres of the ftomach. This particularly ex-
plains why the exercifes of geilation, though not the
mod powerful in ilrcngihening the whole JTyftem, are,
however, very powerful in flrengtheningthe ftcmach;
of which we have a* remarkable proof in the effects of

failing.

* Forms of thcfe tonics may be feen in the preceding notes on
Articles 982, 983, 993.

f See the notes on Articles 982, 983, 993.

In tlieie cafes 'the Tindura Martis, mentioned in the note on Ar-
ticle 1 2 1 2, is as proper a form of chalybeates as any we can ufe. Its
dofc is from ten to twenty drops in any proper vehicle. A glafs of
coldfprin--waicr. acidulated with a few drops of this tincture, is
agreeable and refrefhing, and may be tifed as the patient's commoa
drink ; its agreeablenefs may be confiderably increafed by adding to
each half-pint glafs, a tablc-fpoonful of fimple cinnamon-water.

OF PHYSIC.

123

failing. In {lengthening the general fyfteni, as fa-
tigue muft be avoided, fo bodily exercife is of ambi-
guous ufe; and perhaps it is thereby, that riding on
horfeback has been fo often found to be one of the
moft powerful means of ftrengtfeening the ftomach,
and thereby of curing dyfpepiia.
MCCXVIII.

The other general remedy of dyfpcplia is the appli-
cation of cold : which may be in two ways ; that is,
either by the application of cold air, or or cold water.
It is probable, that, in the atmofphere constantly fur-
rounding our bodies, a certain degree of cold, confiuer-
ably lefs than the temperature of our bodies them-
feives, is neceiTary to the health of the human body.
Such a degree of cold Teems to ftrengthen the vefFcis
on the fnrface of the body, and therefore the mufcular
fibres cf the ftomach. But, further, it is well known,
that if the body is in exercife fufficient to fupport
fuch a determination to the furface, as to prevent the
cold from producing an entire conilridlion of the
pores; a certain degree of cold in the atmofphere,
with fuch exc^ciie, will render the perfpiration more
considerable. From the iharp appetite that in fuch
circumftances is commonly produced, we can have
no doubt, that, by the application of fuch cold, the
tone of the ftomach is confiderably ftrengthened.
Cold air, therefore, applied with exercife, is a moil
powerful tonic with rcfpect to the ftomach : and this
explains why, for that purpofe, no exercifes within
doors, or in clofe carriages, are fo ufeful as thofe in
the open air.

MCCXIX.

From the fame reafoning, we can perceive, that the
application of cold water, or cold bathing, while it is
a tonic with refpecl to the fyftem in general, and e~
fpecially as exciting the action of the extreme veflels,

2 inuft

124 PRACTICE

mail iii both rcfpeds be a powerful means of ftrength-
cning the tone of the ftomach.
MCCXX.

Thefe are the remedies to be employed towards a
radical cure of idiopathic dyfpepfia ; and it might be,
perhaps, expected here, that 1 mould treat alibof the
various cafts of the fympathic difeafe. But it will be
obvious that this cannot be properly don- without
treating of all the difeafes of which the dyfpepfia is a
fymptorn, which cannot be proper in this place. It
has been partly done already, and will be further
treated of in the courfe of this work. In the mean
time, it may be proper to obferve, that there is not
Co much occaiion for diftinguiming between the idi-
opathic and fympathic dyfpepfia, as there is in many
other cafes of idiopathic and fympathic difeafes. For,
as the fympathic cafes of dyfpepfia are owing to alofs
of tone in fome other part of the fyftem, which .is
from thence communicated to the ftomach ; fo the
tone of the ftomach restored, may be communicated
to the part primarily affe&ed ; and therefore the reme-
dies of the idiopathic may be often ufefully employ-
ed, and are often the remedies chiefly employed, in,
fympathic dyfpepfia.

MCCXXI.

Another part of our buiinefs here might be to fay,
how forne other of the urgent fymptoms, befides
thofe above-mentioned, are to be palliated. On this
fubjecl:, 1 think it is enough to fay, that thefymptoms
chieily requiring to be immediately relieved, are flatu-
lency, heartburn, other kinds of pain in the region of
the ftomach, and vomiting;

The dyfpeptic are ready to fuppofe that the whole
of their difeafe coniifts in a flatulency. In this it
will be obvious that they are miftaken ; but, although
the flatulency is not to be entirely cured, but by
mending the imbecility of the ilomach by the means

above-

O F P H Y S I C, 125

above-mentioned ; yet the flatulent didention of the
ilomach may be relieved by carminkives, as they are
called, or medicines rhat produce a difcharge of wind
from the flomach ; fuch are the various aritifpafmo-
dics, of which the mod effectual is the vitriolic aether.

The heartburn may be relieved by abforbents*, an-
tifpafraodics§,or demulcentsf.

The other pains of the ilomach may be fometimes
relieved by carminitives||, but moil certainly by opi-
ates

Vomiting is to be cured tnofl; effectually by opiates
thrown by injection into the anus.

CHAP.

* The abforbeots have been defcribed above, fee note on Article
1296.

§ It may be doubtful whether antifpafmodics are effectual in re-
moving heartburn. Opium undoubtedly often gives relief in dofes
of twenty or thirty drops of laudanum.

-j- Extract of liquorice is as good a demulcent in thefe cafes as any
in the lilt of the Materia Medica. Sucking a little piece of it, and
drinking a cup or two of weak lintfeed-tea after it, feldom fail of
giving relief,

jj Carminatives Cui table in thefe cafes are the eflential oils of the
feeds of fome aromatic umbiliferous plants, as Ol. Anifi. the dofe
of which is fifteen or twenty drops on a piece of fngar, though com-
mon praftice feldom goes half that length. The Oleum I arvi is
another excellent carminative, but it is very hot, and its dofe muifc
never exceed five drops ; two drops are a moderate dofe. 'The O-
Jcum Menthae is another good carminative ; its dofe is two or three
drops on a piece of fugar.

Two grains of the Extract of opium, or forty drops of the lauda-
num, are ufually given in half a cupful of lintfeed tea. The dote
may be incrcafed to 100 drops of laudanum, in the fame quantity of
vehicle, efpecially if the pain of the Ilomach be accompanied with
fomi tings.

126 PRACTICE

C II A P. III.
OF HYPOCHONDRIASIS,

OR THE

HYPOCHONDRIAC AFFECTION,

COMMONLY CALLED

VAPOURS OR LOW SPIRITS.

MCCXXIL

IN certain perfons there is a ftate of mind diftin-
guiihed by a concurrence of the following cir-
cumiiances : A langour, liftlelTnefs, or want of refolu-
tion and activity with refpecl to all undertakings ; a
difpoiitlon to ferioufnefs, fadncfs, and timidity ; as to
all future events, an appreheniion of the worft or moft
unhappy ftate of them ; and therefore, often upon
flight grounds, an appreheniion of great evil. Such
perfons are particularly attentive to the ftate of their
own health, to even the fmalleft change of feeling in
their bodies; and from any unufual feeling, perhaps
of the High ted kind, they apprehend great danger,
and even death itfclf. In refpecl: to all thefe feelings
and appreheniions, there is commonly the molt obfti-'
nate belief and perfuafion.

MCCXXIII.

This ftate of mind is the Hypochondriafis of medi-
cal writers. See Linmsi Genera Morborum, Gen.
76. et Sagari Syfiema Symptomaticum, Clafs XIII.
Gen. 5. The fame ftate of mind is what has been
commonly called Vapours and Low Spirits. Though
the term Vapours may be founded on a falfe theory,
and therefore improper, I beg leave, for a purpofe

that

OF PHYSIC. 127

tbat will immediately appear, to employ it for a little

here,

MCCXXIV.

Vapours, then, or the Hate of mind defcribed above,
is, Lke every other ftate of mind, conne&ed with a
a certain ftate of the body, which muft be inquired in-
to in order to its being treated as a difeafe by the art
of phyfic.

This ftate of the body, however, is not very eafily
afcertained : for we can perceive, that on different oc-
cafions it is very different; vapours being combined
fometirnes with dyfpepfia, fometimes with byiteria, and
fometimes with melancholia, which are difeafes feem-
ingly depending on very different ftates of the body.
MCCXXVI.

The combination of vapours with dyfpepfia is very
frequent, and in feemingly very different circuroftan-
ces. it is, efpeeiaily, thefe different circumftances
that I would wifli to afcertain ; and I remark, that they
are manifeftly of two different kinds. Firft, as the
difeafe occurs in young perfons of both fexes, in per-
fons of a fanguine temperament, and of a lax and flac-
cid habit. Secondly, as it occurs in elderly perfons of
both fexes, of a melancholic temperament, and of a
firm and rigid habit.

MCCXXVII.

Thefe two different cafes of the combination of the
vapours and dyfpepfia, I confider as two diftincl: dif-
eafes, to be diftinguifhed chiefly by the temperament
prevailing in the perfons affected.

As the dyfpepfia of fanguine temperaments is often
without vapours; and as the vapours when joined
with dyfpepfia in fuch temperaments, may be conii-
dered as, perhaps, always a fymptom of the affeclion
of the ftomach ; fo to this combination of dyfpepfia
and vapours, I would ftill apply the appellation of

128 PRACTICE

confider it as flricHy the difcafe treated
of jn the preceding chapter,

But the combination of dyfpepfia and vapours in
melancholic temperaments, as the vapours or the
turn of mind peculiar to the temperament, nearly that
defcribed above in MCCXXII. are efTential circumilan-
ces of the difcafe ; and as this turn of mind is often
with few, or only flight fymproms of dyfpepfia ; and,
even though the latter* be attending, as they feem to
be rather the effects of the general temperament, than
of any primary or topical affection of the ilomach ; I
confider this combination as a very different difeafe
from the former, and would apply to it ftridly the ap-
pellation of Hypochondria fis.

MCCXXVIII.

Having thus pointed out a diftincHon between Dyf-
pepfia and Hypochondriacs, I fhall now, ufing thefe
terms in the flricl fenfe above mentioned, make fome
cbfervations which may, I think, illuftrate the fubjecl,
and more clearly and fully eflablifh the diflindtion
propofed.

MCCXXIX.

The dyfpepfia often appears early in life, and is
frequently much mended as life advances : but the
hypochondriacs feldom appears early in life, and more
ufually in more advanced years only ; and more cer-
tainly ftill, when it. has once taken place, it goes on
increafmg as life advances to old age.

This feems to be particularly well ill unrated, by
our obferving the changes in the flate of the mind
which ufually take place in the courfe of life. In
youth, the mind is chearful, aclive, rafh, and movea-
ble : but as life advances, the mind by degrees be-
comes more ferious, flow, cautious, and fteady ; till at
length, in old age, the gloomy, timid, diftruiiful, and
obitinate Mate of melancholic temperaments, is more
exquifitely formed. In producing thefc changes, it is

true,

OF PHYSIC. 129

true, that moral caufes have a flrire ; but it is at the
lame time obvuus, that the temperament of the body
determines the operation of thefe moral caufes, fooner
or later, and in a^reater or leffer degree, to have their
effects. The fanguine temperament retains longer the
character of youth, while the melancholic tempera-
ment brings on more early the manners of old age.

MCCXXX,

Upon the whole, it appears, that the (late of the
mind which attends, and efpecially diitinguifhes hy-
pochoqdriafis, .is the effect of that fame rigidity of the
folios, torpor of the nervous power, and peculiar ba-
lance between the arterial and venous fyftems which
occur in advanced life, and which at all times take
place more or lefs in melancholic temperaments. If
therefore there bealfo fomewhatof a like flats of mind
attending the dyfpepfia which occurs early in life in
fanguine temperaments and lax habits, it mult depend
upon a different Itate of the body, and probably.up-
on a weak and moveable ftate of the nervous power.

MCCXXXJ.

Agreeable to all this, in dyfpepfia, there is more of
fpaimodic affection, and the affection of the mind (M-
ccxxn.) is often abfent, and, when prefent, is perhaps
always of a ilighter kind : while, in hypochondriacs,
the affection of the mind is more conitant, and the
fymptorns of dyfpepfia, or the affections of the fto-
mach, are often abfent, or, when prefent, are in a
/lighter degree. ,

I believe the affection of the mind is commonly dif-
ferent in the two difeafes. In dyfpepfia, it is often
languor and timidity only, eafily difpelled ; while in
hypochondriacs, it is generally the gloomy and ri-
vetted apprehenfion of evil.

The two difeafes are alfo diftingui/hed by fomc o-
ther circumftances. Dyfpepfia, as I have fuid, is off-
en a fymptomatic affection ; while hypochondriacs
VOL. II. R is,

r jd PRACTICE

is, perhaps, always a primary and idiopathie difeafe.
As debility may be induced by many different cauf-
cs, dyfpepfia is a frequent difeafc ; while hvpochondri-
afisD depending upon a peculiar temperament, is more
rare.

MGCXXXII. .

Having thus endeavoured to diftinguifli the two di£
eafes, I iuppofb the peculiar nature and proximate
caufe of Hypochondria/is will be understood ; and I
proceed therefore to treat of its cure.

So far as the affections of the body, and particular-
ly of the flomach, are the fame here as in the cafe of
dyfpefifia, the method of cure might be fuppofeti to be
allb the fame ; and accordingly the practice has. been
carried on with little diitinction : but I am perfuaded
that a diflinclion is often 'necefiary.
MCCXXX11I.

There may be a foundation here for the fame pre-
'fervativc indication as firft laid down in the cure of
dyfpepfia-y (MCCII.) but I cannot treat this fubjeft fo
clearly or fully as I could wiili, becaufe I have noc
yet had fo much opportunity of obfervation as I think
necefiary to ascertain the remote caufes ; and 1 can
hardly make life of the observations of others, who
have feldom or never diftinguiihed between the two
difeafes. What, indeed, has been fald with rcfpecl to
the remote caufes of melancholia, will often apply to
the hypochondriacs, which I now treat of; but the
fubject of the former has been fo much involved in a
doubtful theory, that I find it difficult to feleft the
facts that might properly and ilricliy apply to the
latter. I delay this fubjed;, therefore, till another oc-
cafion ; but in the mean time trull, that what I have
fatd regarding the nature of the difeafe, and fome re-
marks I fhall have occaiion to offer in confidering the
method of cure, may in foms meafure fupply my defi-
ciency on this fubjed of the remote caufes.

MCCXXXIV.

O F P H Y S I C, 131

MCCXXXIV.

The fecond indication laid down in the cure of dyf-
•jpepfia (MCCI.) has properly a place here: but it is itill
to be executed with fome diitinction.
MCCXXXV.

An anorexia, and accumulation of crudities in the
.ftomach, does not fo commonly occur in hypochon-
driafis as in dyfpepiia ; and therefore vomiting (M-
cciv.) is not io often necetfary in the former as in
the 'latter.

MCGXXXVI.

The tymptcm of excefs of acidity, from the flow
evacuation of the ftomach in melancholic tempera-
ments, often arifes to a very hi6h degree in hypochon-
drialis ; and therefore, for the fame reafon as in MCCV.
it is to be obviated and corrected with the utmoft
care. It is upon this account that the feveral anta-
cids, and the other m,eans of obviating acidity, are to
be employed in hypochondriails, and with the fame
attentions and confederations as in MCCVI. and follow-
ing ; with this reflection, however, that the exciting
the action of the ilomach there mentioned, is to be
a little differently undcrftood, as {hall be hereafter
explained.

MGGXXXVII.

As coflivenefs, and that commonly to a confiderable
degree, is a very conftant attendant of hypochondria-
fis, fo it is equally hurtful as in dyfpepfia. It may be
remedied by the fame means in the former as in the
latter, and they -are to be employed with the fame rer
Unctions as in MCCX.

MCCXXXVIIF.

It is efpecially with refpect to the third indication
Jaid down in the cure of dyfpepfia (MCCI.) that there
is a difference of practice to be obferved in the cure
of hypochondriacs ; and that often one directly op-

R 2

132 PRACTICE

pofite to that in the cafe of dyfpepHa, is to be fol-
lowed.

MCXXX1X.

In dyfpepfia, the chief remedies are the tonic medi- •
cines, which to me feem neither neceffary nor fafe in
hypochondriacs ; for in this there is not a lofs of
tone, but a want of activity that is to be remedied.

Chalybeate mineral waters have commonly been
employed in hypochondriacs, and feemingly withfuc-
cefs. But this is probably to be imputed to the arnufe-
ment and exercife ufually accompanying the ufe of
thefe waters, rather than to the tonic power of the
frnall quantity of iron which they contain. Perhaps
the elementary water, by favouring the excretions^ .
mav have a mare in relieving the difeafe.

MCCXL.

Cold bathing is often highly ufeful to the dyfpeptic,
and, as a general fiimulant, may fometimes feern ufeful
to the hypochondriac; but it is not commonly fo to
the latter ; while, on the other hand, warm bathing,
hurtful to the dyfpeptic, is often extremely ufeful to
the hypochondriac.

MCCXLI.

Another inftance of a contrary practice neceffary in ;
the two difeafes, and illuflrating their refpective na-|
tures, is, that the drinking tea and coffee is always
hurtful to the dyfpeptic, but is commonly extremely
ufeful to the hypochondriac.

MCCXLII.

Exercife, as it ftrengthens the fyftcm, and thereby,,
the ftomach, and more efpecially, as by increafing the
perfpiration, it excites the action of the ftomach, it$
proves one of the mod ufeful remedies in dyfpepfia ;
and further, as, by increafing the perfpiration, it ex--
cites the activity of the ftomach, it likewife proves air
ufeful remedy in the hypochondriaiis,. However, itf
the latter cafe, as I fhail explain prefently, it is ftill a'

more

O F PHYSIC. 133

more ufeful remedy by its operation upon the mind
than by that upon the bodv.

MCCXLIII.

It is now proper that we proceed to confider the
mod important article of our practice in this difeafe,
and which is, to confider the treatment of the mind ;
an affection of which fornetimes attends dyfpepfia, but
is always the chief circumftance in hypochondriacs.
What 1 am to tugged here, will apply. to both difeafes ;
but it is the hypochondriacs that I am to keep moil
conftantly in view.

MCCXLIV.

The management of the mind in hypochondriacs,
is often nice and difficult. The firm pe fuaiion that
generally prevails in fuch patients, does not allow their
feelings to be treated as imaginary, nor their appre-
henfion of danger to be confidered as groundlels,
though the phyfician may be perfuaded that it is the
cafe in both relpecls. Such patients, therefore, are
not to be treated either by raillery or by reafoning.

It is fa id to be the manner of hypochondriacs to
change often their phyfician ; and indeed they often
do it confidently ; for a phyfician who does not admit
the reality of the difeafe, cannot be fuppofed to take
much pains to cure it, or to avert the danger of which
he entertains no appreheniion.

If in any cafe the pious fraud of a placebo be al-
lowable, it feems to be in treating hypochondriacs :
who, anxious for relief, are fond of medicines, and,
though often difappointed. will dill tade every new
drug that can be propofed to them.
MCCXLV.

As it is the nature of man to indulge every prefent
motion, fo the hypochondriac cherifhes his fears, and,
attentive to every feeling, finds in trifles light as air a
ftrong confirmation' of his appreheniions. His cure
therefore depends especially upon the interruption of

his

134 PRACTICE

his attention, or upon its being diverted to other ob*
jeds than his own feelings.

MCCXLVI.

Whatever averficn tc application of any kind may
appear in hypochondriacs, there is nothing more per*
nicious to them than abfclute idlenefs, or a vacancy
from all earneft purfuit. It is owing to wealth admit-
ting of indolence, and leading to the purfuit of tranfi-
tory and unfatisfying amufements, or to that of ex-
hauiling pleasures only, that the prefent times exhibit
to us fo many inflances of hypochondriacifm.

The occupations of buiinefs fukable to their cir-
cumftances and fituation in life, if neither attended
with emotion, anxiety, nor fatigue, are always to be
admitted, and p.rliited in by hyponchondmcs. But
occupations upon which a man's fortune depends, and
•whicii are always j therefore, objects of anxiety to me-
lancholic men ; and more particularly where fuch oc-
cupations are expofed to accidental interruptions, dif-
vippointments, and failures, it is from theie that the
hypochondriac is certainly to be withdrawn.
MCCXLVII.'

The hypochondriac, who is not necefTarily, by cir-*
cumftances or habits, engaged in buiinefs, is to be
drawn from his auction to his own feelings by fofne
amufement.

The various kinds of fport and hunting, as purfued
with forne ardour, and attended with exerciie, if not
too violent, are amongft the mod ufeful.

All thole amufements which are in the open air,
joined with moderate exercife, and requiring fome
dexterity, are generally of ufe.

Within doors, company which engages attention,
which is willingly yielded to, and is at the fame time
of a chearfui kind, will be always found of great
fervice.

Play, in which fome fkill is required, and where

the

OF PHYSIC. 135

the flake is not an object of much anxiet J5 if not too
long pro traded, may often be admitted.

In dyfpeptics, however, gaming, liable to fuddcn
and coimderable emotions, is dangerous, and the long
continuance of it, with night-watching, is violently
debilitating. But in melancholies, who commonly
excel in (kill, and are leis fufceptible of violent emo-
tions, it is more admiflible, and is often the only a-
mufemerit that can engage them.

Mufic, to a nice ear, is a hazardous amufement, as
long attention to it is very fatiguing.
MCCXLVIII.

It frequently happens, that amufements of every
kind are rejected by hypochondriacs ; and in that cafe,
mechanical means of interrupting thought are the re-
medies to be fought for.

Such is to be found in brife exercife, which requires
fome attention in the conduct of it.

Walking is leldom of this kind; though, as grati-
fying to the reftleifnefs of hypochondriacs, it hasfome-
times been found ufeful.

The required interruption of thought is beft obtain-
ed by riding on horfeback, or in driving a carnage of
any kind.

The exercife of failing, except it be in an open
boat, engaging fome attention, does very little djer-
vice.

Exercife in an eafy carriage, in the direction of
which the traveller takes no part, unlefs it be upon
rough roads, or driven pfetty quickly, and with long
continuance, is of little advantage.
MCCXLIX.

Whatever exercife may be employed, ic will be
moft effectual when employed in the purfuit of a jour-
ney ; firft, becaufe it withdraws a perfon from many
objects of unealinefs and care which might prefent
themfelves at home ; fecondly, as it engages in more

con-

136 PRACTICE

conftantexercife, and in a greater degree of it than is
commonly taken in airings about home; and, laflly,
as it is conftantly prefenting new objects which c;ill
forth a perfon's attention.

MCCL.

In our fyftem of Nofology we have, next to Hypo-
chondriaiis, placed the Chlorofis, bccaufe I once
thought it might be confidered as a genus comprehend-
ing, beiides the Chlorolis of Amenorrhcea, fome fpe-
cies of Cachexy : but, as I cannot find this to be well
founded, and cannot diftinctly point out any fuch dif-
eafe, I now omit confidenng Chlorofis as a genus
here; and, as a fymptom of Amenorrhcea, I have
endeavoured before to explain it under that title.

BOOK III.

O F

SPASMODIC AFFECTIONS,
WITHOUT FEVER.

MCCLI.

UNDER this title 1 am to comprehend all the
difeafes which confift in motu abnormi ; that is,
in a preternatural ftate of the contraction and motion -
of the mufcular or moving fibres in any part of the
body.

MCCLII.

It will hence appear, why, under this title, I have
comprehended many more difeafes than Sauvages and
Sagar have comprehended under the title of fpafmi,
or that Linnaeus has done under the title of Motorii.

But

O F P H Y S I C. 137

But I expect it will be obvious, that, upon this occa-
iion, it would not be proper to confine our view to
the affections of the voluntary motion only ; and if
thofe Nofologifts have introduced into the clafs of
Spafmi, Palpitatio and Hvfteria, it will be with equal
propriety that Afthma,Coiica, and many other difeafes,
are admitted.

MCCLIIL

It has been hitherto the method of our Nofologifts
to divide the Spafmi into the two orders of Tonici and
Clonici, Spaftici and Agitatorii ; or, as many at pre-
fent ufc the terms, into Spafrns ftridly fo called, and
convuliions. I find, however, that many, and indeed
moft of the difeafes to be confidered under our title of
Spafmodic affections, in refpect of tonic orCloric con-
tractions, are of a mixed kind : and, therefore, I can-
not follow the ufual general divilion ; but have at-
tempted another, by arranging the feveral Spafmodic
difeafes according as they arlecl the feveral functions,
Animal, Vital, or Natural.

SECT. I.

OF THE SPASMODIC AFFECTIONS OF THE
ANIMAL FUNCTIONS.

MCCLIV.

AGREEABLE to the language of the ancients, the
whole of the difeafes to be treated of in this feclion
might be termed fpajm; and many of the moderns
continue to apply the term in the fame manner : but I
think it convenient to diflinguim the terms of Spa fin
and Convulfion, by applying the former, ftrictly to

VOL. II. S what

138 PRACTICE

what has been called the Tonic; and the latter, to
what has been called the Clonk Spafm. There is cer-
tainly a foundation for the ule of thofe different terms,
as there is a remarkable difference in the ftate of the
contraction of moving fibres upon different occaiions.
This I have indeed pointed out before in my treatife
of Phyfiology, but mutt alfo repeat ii here.
MCCLV.

In the exercife of the feveral functions of the ariimal
ceconcrny, the contractions of the moving fibres are
excited by the will, or by certain other caufes fpecially
appointed by nature for exciting thofe contractions ;
and thele other caufes I name the natural caufes. In
a (late of health, the moving fibres are contracted by
the power of the will, and by the natural caufes only.
At the fame time the contractions ufed are in force
and velocity regulated by the will, or by the circum-
ftances of the natural caufes ; and the contractions,
whether produced by the one or the other, are always
foon fucceeded by a flate of relaxation, and are not
repeated but when the power of the will or of the na-
tural caufes is again applied.

MCCLVL

Such are the conditions of the action of the moving
fibres in a ftate of health ; but in a morbid flate the
contractions of the muicles and moving fibres ordina-
rily depending upon the will are- excited without the
concurrence of the will, or contrary to what the will
intends; and in the other functions they are excited
by the action of unufual and unnatural caufes. In
both cafes, the contradictions produced may be in two
different ftates. The one is, when the contradictions
are to a more violent degree than is ufual in health,
and are neither fucceeded by a fpontaneons relaxa-
tion, nor even readily yield to an extenfion either
from the action of antagonist mufcles, or from other
extending powers applied. The ftate of contractions

is

O F P H Y S I C. 139

is what has been called a tonic fpafm, and is what I
fhall name limply and ftrictly a fpafm. The other
morbid ilate of contraction is, when they are fucceed-
ed by a relaxation, but are immediately again repeated
without the concurrence of the will or of the repeti-
tion of natural caufe*, and are at the fame time com-
monly, with refpect to velocity and force, more vio-
lent than in a healthy ftate. This (late of morbid
contraction is what has, been named a clonic Jpafm, and
ivhat I fhall name (imply and flrictly a convuljion.

In this fedion I ihall follow nearly the ufuai divifion
of the fpafmodic difeafes into thofe confiding in Spafm,
and thofe confiding in convulflon; but it may not
pernaps be in mv power to follow fuch divifion ex-
actly.

CHAP. I.

OF TETANUS.

MCCLV1I.

BOTH Nofologifls and Practical writers have dif-
tinguifhed Tetanic complaints into the feveral
fpecies of Tetanus, Opiflhotonos, and Emprofthoto-
nos ; and I have in my Nofology put the Trifmus, or
Locked Jaw, as a genus diilinct from the Tetanus. —
All this, however, I now judge to be improper ; and
am of opinion, that ail the feveral terms mentioned,
denote, and are applicable only to, different degrees
of one and the fame difeafe ; the hiftory and cure of
which I fhall endeavour to deliver in this chapter.

MCCLVIII.

Tetanic complaints may, from certain caufes, occur
82 • in

i4o PRACTICE

ia every climate that we are acquainted with j but they
occur mod frequently in the warmed climates, and
moil commonly in the warmed feaibns of fuch cli-
mates. Thefe complaints affect all ages, fexes, tem-
peraments, and complexions. The caufes from whence
they commonly proceed, are cold and moidure appli-
ed to the body while it is very warm, and efpecially
the fudden viciffitudes or' heat and cold. Or, the dif-
eafe is produced by puncture, lacerations, or other le-
fions of nerves in any pare of the body. There are,
probably, fame other caufes of this difeafe ; but^they
are neither difti nelly known, nor well afcertained.
Though the caufes mentioned do, upon occafion, affect
all forts of perfons. they feem however to attack per-
fons of middle age more frequently than the older or
younger, the male fex more frequently than the female,
and the robud and vigorous more frequently than the
weaker.

MCCL1X.

If the difeafe proceed from cold, it commonly comes
on in a few days after the application of fuch cold ;
but, if it arife from a puncture or other lefion of a
nerve, the difeafe does not commonly come on for
many days after the lefion has happened, very often
•when there is neither pain nor unealinefs remaining in
the wounded or hurt part, and very frequently when
the wound has been entirely healed up.

MCCLX.

The difeafe fometimes comes on fuddenly to a vio-
lent degree, but more generally it approaches by flow
degrees to its violent date. In this cafe it -comes on
with a fenfc of diffnefs in the back-part of the neck,
which, gradually increafmg, renders the motion of the
head difficult and painful. As the rigidity of the
neck comes on and increafes, there is commonly at
the fame time a fenfe of uneafinefs felt about the root
of the tongue ; which by degrees, becomes a difficul-
ty

OF PHYSIC, 141

ty of fwallowing, and at length an entire interruption
of it. While the rigidity of the neck goes on increaf-
ing, there arifes a pain, often violent, at the lower
end of the fternum, and from thence mooting into the
back. When this pain arifes, all the mufcles of the
neck, and particularly thole of the back part of it, are
immediately affected with fpafm, pulling the head
ftrongly backwards. At the fame time, the mufcles
that pull up the lower jaw, which upon the firft ap-
proaches of the difeafe were affected with fome fpaitic
rigidity, are now generally affected with more violent
fpafm, and fet the teeth fo clofely together, that they
do not admit of the fmalleft opening.

This is what has been named the Locked Jaw> and
is often the principal part of the difeafe. When the
difeafe has advanced thus far, the pain at the bottom
of the fternum returns very frequently, and with it the
fpafms of the hind-neck and lower-jaw a,re renewed
with violence and much pain. As the difeafe thus
proceeds, a greater number of mufcles come to be af-
fected with fpafms. After thofe of the neck, thofe
along the whole of the fpine become affected, bending
the trunk of the body ftrongly backwards , .and this 13
what has been named the Opiftbotoncs.

In the lower extremities, both the flexor and ex-
tenfor mufcles are commonly at the fame time affected,
and keep the limbs rigidly extended. Though the
cxtenfors of the head and back are ufually the moil
ftrongly affected, yet the flexors, or thofe mufcles of
the neck that pull the head forward, and the mufcles
that fhould pull down the lower jaw, are often at the
fame time ftrongly affected with fpafm. During the
whole of the difeafe, the abdomin.il mufcles are vio-
lently affected with fpafm, fo that the belly isftrorgiy
retracted, and feels hard as a piece of board.

At length the flexors of the head and trunk become
fo ftrongly affected as to balance the extenfcrs, and to

keep

PRACTICE

keep the head and trunk ftraight, and rigidly extend-
ed, incapable of being moved in any way ; and it is
to this date the term Tetanus has been ftridly applied.
At the fame time, the arms, little affected before, are
now rigidly extended -y the whole of the mufcles be-
longing to them being affected with fpafms, except
thofe that move the fingers, which often to the laft
retain fome mobility. The tongue alfo long retains
its mobility ; but at length it alfo becomes affected
with' fpafms, which, attacking certain of its mufcles
only, often thruft it violently out between the teeth.

At the height of the difeafe, every organ of volun-
tary motion feems to be affected ; and amongft the
reft, the mufcles of the face. The forehead is drawn up
into furrows, the eyes fometimes diflorted, are com-
monly rigid, and immoveable in their fockets; the nofe
is drawn up, and the cheeks are drawn backwards to-
wards the ears, fo that the whole countenance expreff-
es/the moil violent grinning. Under thefe univerfal
fpafms, a violent convulilon commonly comes on, and
puts an end to life.

MCCLXI.

Thefe fpafms are every where attended with moil
violent pains. The utmofl violence of fpafm is, how-
ever, not conftant ; but, after fubfifting for a minute
or two, the mufcles admit of fome remiflion of their
contraction, although of no fuch relaxation as can al-
low the action of their antagonifls. This remiffion of
contraction gives alfo fome remiflion of pain ; but
neither is of long duration. From time to time, the
violent contractions and pains are renewed fometimes
every ten or fifteen minutes, and that often without
any evident exciting caufe. But fuch exciting caufes
frequently occur ; for almolt every attempt to motion,
as attempting a change of pofture, endeavouring to
f wallow, and evtn to fpeak, fometimes gives occafion
to a renewal of the fpafms over the whole body.

MCCLXII.

OF PHYSIC.

MCCLXII.

The attacks of this difeafe are feldom attended
with any fever. When the fpafms are general and
violent, the pulfe is contracted, hurried, and irregu-
lar ; and the refpiration is afft-cted in like manner :
but, during the remiffion, both the pulfe and refpira-
tion ufually return to their natural ftate. The heat of
the body is commonly not increafed ; frequently the
face is pale, with a cold fweat upon it ; and very ofcen
the extremities are cold, with a cold fweat over the
whole body. When, however, the fpafms are fre-
quent and violent, the pulfe is fometimes more full and
frequent than natural ; the face is flufhed, and a warm
fweat is forced out over the whole body.
MCCLXIIL

Although fever be not a comtant attendant of this
difeafe, cfpecially when arifmg from a leiion of nerves ;
yet, in thofe cafes proceeding from cold, a fever fome-
times has fupervened, and is faid to have been at-
tended with inflammatory fymptoms. Blood has been
often drawn in this difeafe, but it never exhibits any
inflammatory cruft ; and all accounts feem to agree,
that the blood drawn feems to be of a loofer texture
than ordinary, and that it does not coagulate in the
ufual manner.

MCCLXIV.

In this difeafe the head is feldom affected with deli-
rium or even confufion of thought, till the lafl ftage
of it ; when, by the repeated fhocks of a violent
diftemper, every function of the fyflcm is greatly dif-
ordered.

MCCLXV.

It is no leis extraordinary, that, in this violent dif-
eafe, the natural functions are not either immediately
or confiderably affected. Vomitings fometimes ap-
pear early in the difeafe, but commonly they are not
continued ; and it is ufual enough for the appetite of

hunger

144 PRACTICE

hunger to remain through the whole courfc of the dif-
eafe ; and what food happens to be taken down, feems
to be regularly enough digefted. The excretions are
fometimes affected, but not always. The urine is
fometimes fuppreffed, or is voided with difficulty and
pain. The belly is coflive: but, as we have hardly
any accounts excepting of thofe cafes in which opiates
have been largely employed, it is uncertain whether
the coftivenefs has been the effect of the opiates or of
the difeafe. In feveral instances of this difeafe, a mi-
liary eruption has appeared upon the fkin ; but whe-
ther this be a fymptom of the difeafe, or the effect of a
certain treatment of it, is undetermined. In the mean
while, it has not been obferved to denote either fafety
or danger, or to have any effect in changing the courfe
of the diilemper.

MCCLXVI.

This difeafe has generally proved fatal ; and this
indeed may be juftly fuppofed to be the confequence
of its nature: but, as we know, that, till very lately,
phyiicians were not well acquainted with a proper me-
thod of cure ; and that fince a more proper method
has been known and practifed, many have recovered
from this difeafe ; it may be therefore concluded, that
the fatal tendency of it is not fo unavoidable as has
been imagined.

In judging of the tendency of this difeafe, in parti-
cular cafes, we may remark, that, when arifing from
lefions of the nerves, it is commonly more violent, and
of more difficult cure, than when proceeding from
cold ; that the difeafe which comes on fuddenly, and
advances quickly to a violent degree, is always more
dangerous than that which is flower in its progrefs.
Accordingly, the difeafe often proves fatal before the
fourth day ; and, when a patient has palled -this peri-
od, he may be fuppofed to be in greater fafety, and iri
general the difeafe is the fafcr the longer it lias con-
tinued.

O F P H Y S I C. 145

tinued. It is however, to be particularly obferved,
that, even for many days after the fourth, the difeafe
continues to be dangerous ; and, even after fome con-
fiderable abatement of its force, it is ready to recur
again with its former violence and danger. It never
admits of any fudden, or what may be called a critical
folution ; but always recedes by degrees only, and it is
often very long before the whole of the fymptoms
difappear.

MCCLXVII,

From the hiflory of the difeafe now defcribed, it
will be evident, that there is no room for diftinguilh-
ing the tetanus, opi/ihotonos, and trljmut or locked jaw,
as different fpecies of this difeafe, iince they all arife
from the fame caufes, and are almofl conflantly con-
joined in the fame perfon, I have no doubt that the
emprofthotonos belongs alfo to the fame genus ; and as
the ancients have frequently mentioned it, we can have
no doubt of its having occurred ; but, at the fame
time, it is certainly in thefe days a rare occurrence j
and, as I have never feen it, nor find any hiftcries in
which this particular ftate of the fpafms is faid to have
prevailed, I cannot mention the other circumilances
which particularly attend it, and may difting'uifh it
from the other varieties of tetanic complaints,
MCCLXVIII.

This difeafe has put on Hill a different form from
any of thofe above mentioned. The fpafins have been
fometimes confined to one fide of the body only, and
which bend it ftrongly to that fide. This is what has
been named by Sauvages the. tetanus Lateralis, and
by fome late writers the Pkuroftbctonos. This form
of the difeafe has certainly appeared very feldom ;
and, in any of the accounts given of it, I cannot find
any circumftances that would lead me to confider it as
any other than a variety of the fpecies already menti-
oned, or to take further notice of it here.

VOL, II. T MCCLXIX

146 PRACTICE

MCCLXC£.

The pathology of this difeafc I cannot in any mea-
fure attempt ; as the ftructure of moving fibres, the
ftate of them under different degrees of contradion,
and particularly the ftate of the fenforium, as varioufly
determining the motion of the nervous power, are all
matters very imperfectly, or not at all, known to me.
In fuch a fituation, therefore, the endeavouring to give
any rules of pra&ice, upon a fcientific plan, .appears
to me vain and fruitlefs ; and towards directing the
cure of this difeafe, we mull be fatisfied with having
learned fomething ufeful from analogy, confirmed by
experience.

MCCLXX.

When the difeafe is known to arife from the lefioa
of a nerve in any part of the body, the firit, and, as I
judge, the moft important flep to be taken towards the
cure, is, by every poffible means, to cut off that part
from all communication with the fenforium, either by
cutting through the nerves in their courfe, or perhaps-
by deftroying, to a certain length, their affected part
or extremity.

MCCLXXI.

When the cure of the difeafe is to be attempted by-
medicine, experience has taught us that opium has
often proved an effectual remedy ; but that, to render
it fuch, it mufl be given in much larger quantities
than have been employed in any other cafe ; and in
thefe larger quantities, it may, in this difeafe, be given
more fafely than the body has been known to bear in
any other condition. The practice has been, to give
the opium either in a folid or a liquid form, not in
any very large dofe at once, but in moderate dofes,
frequently repeated, at the interval of one, two, three
or more hours, as the violence of the fymptorns feems
to require*. Even when large quantities have been

given

* Though the exhibition of opium in Tetanus has been the mod

O F P H Y S I C. 147

given in this way, it appears that the opium does not
operate here in the fame manner as in moft other ca-
fes; for, though it procures fome remiffion of the fpafms
and pains, it hardly induces any fleep, or occalions that
ftupor, intoxication, or delirium, which it often does
in other circumflances, when much fmaller quantities
only have been given. Jt is therefore very properly
obferved, that, in tetanic affections, as the opium
fliows none of thofe affections by which it may endan-
ger life, there is little or no reafon for being fparing in
the exhibition of it ; and it may be given, probably
ihould be given, as largely and as fail as the fymptoms
of the difeafe may feeui to demand.

It is paiticularly to be obferved, that though the
firft exhibitions of the opium may have produced
fome re million of the fymptoms, yet the eifecls of
opium do not long continue in the fyftem \ and this

T 2 difeafe

univerfal practice, it muft nevertheless be acknowledged, that, in ma-
ny, if not in moft cafes, it has been ineffectual. The difeafe, indeed
is in^gensrai fatal ; but, in molt of the cafes that terminated happi-
ly, opium has been given, as the Author defcribes, cith-er in large
dofes, or frequently repeated fmall dofes, we muft ncceflarily conclude
that the practice ought to be followed.

I have fecn only one cafe of Tetanus ; it proceeded from a wound
which a carpenter received in the wrift of his left arm with a faw.
The inflammation was violent : the ftiffnefs of the neck at firft ap-
peared on the third day, when the inflammation began to abate after
bleeding, and the application of emollient poultices j the pulfe was
weak and fmall ; thirty drops of laudanum were given ; the fymp-
toms increafed ; and, on the day following, the jaw became fixed.
Thirty drops of laudanum were repeated ; and the fyraptoms abat-
ing within two hours after its exhibition, indicated a repetition of
the dofe, which, from its good effects, was a fouith time repeated
the fame day. The wound fuppurated ; and the day following, with
two dofes of forty drops of laudanum, the fymptoms of Tetanus
wholly difappeared, but left the patient in a moil debilitated ftate.
A coftivenefs fupervened, that was removed with the ufe of manna
and Glauber's falts occafionally : The patient was nourished with
rich broths and wine ; but he did not recover his former ftrength
till after fix weeks, although the wound was healed in half that time*

14$ PRACTICE

difeafe being for fonie time ready to recur, it is com-
inonly very neceffary, by the time that the effedts of
the opium given may be fuppofed to be wearing off,
and efpecially upon the leal! appearance of a return
of thefpafms, to repeat the exhibition of the opium in
the fame quantities as before. This practice is to be
continued while the difeafe continues to (how any dif-
pofition to return ; and it is only after the difeafe has
already fubliited for fome time, and when coniiderable
and long ~ continued remiffions have taken place, that
the dofes of the opium may be dirninifhed, and the
intervals of exhibiting them be more coniiderable.
MCCLXXil.

The adminiftering of opium in this manner, has in
many cafes been iiiccefsful; and probably would have
been equally fo in many. others, if the opium had nee
been too fparingly employed, either from the timidity
of practitioners, or from its. exhibition being prevent-
ed by that interruption of deglutition which fo often
attends this" difeafe. This latter circumflance directs,
that the medicine fhould be immediately and largely
employed upon the firft approach of the difeafe, be-
fore the deglutition becomes difficult ; or that, if this
opportunity be loft, the medicine, in fuiScient quan-
tity, and with due frequency, ihould be thrown into
the body by glyfter ; which, however, does not feem
to have been hitherto often pradifed.
MCCJ.XXUI.

•It is highly probable, that, in this difeafe, the intcf-
tines areaifedted with the fpafni that prevails fo much
in other parts of the fyftem ; and therefore, that coitive-
nefs occurs here as a fymptom "of the difeafe*. It is
probably alfo increafed by the opium, which is here
fo largely employed j and, from whichever of thefe

caufes

i

* This fymptom occurred in the cafe mentioned in the preceding
note.

OF PHYSIC, 149

caufes it arifes, it certainly muft be held to aggravate
the difeafe, and that a relaxation of the inteftinal ca-
nal will contribute to a relaxation of the fpafms elfe-
where. This conlideration directs the frequent exhi-
bition of laxatives while the power of deglutition re-
mains, or the frequent exhibition of glyfters when it
does not ; and the good effects of both have been fre-
quently obferved.

MCCLXXIV.

It has been with fo.me probability fuppofcd, that
the operation of opium in this difeafe, may be much
affifted by joining with itforne other of the moil pow-
erful antifpafrnodics. The mod promiling are mufk
and camphire ; and fome practitioners have been of
opinion, that the former has proved very ufeful in te-
tanic complaints. But, whether it be from its not
having been employed of a genuine kind, or in fuffi-
cient quantity, the great advantage and propriety of
its ufc are not yet clearly ascertained. It appears to
me probable, that analogous to what happens with re-
fpecl to opium, both mufk and camphire might be em-
ployed in this difeafe, in much larger quantities than
they commonly have been in other cafes.
MCCLXXV.

Warm bathing has been commonly employed as a
remedy in this difeafe, and often with advantage ; but,
fo far as I know, it has not alone proved a cure ; and,
in fome cafes, whether it be from the motion of the
body here required, exciting the fpafms, or from the
fear of the bath, which fome perfons were feized with,
I cannot determine ; but it is allowed, that the warm
bath hath in fome cafes done harm, und even occafi-
oned death. Partial fomentations have been much
commended, and, I believe, upon good grounds : And
I have no doubt but that fomentations of the feet and
legs, as we now ufually apply them in fevers, might,

without

*5° PRACTICE

without much (lirring of the patient, be very aflidu-
ouily employed with advantage.
MCCLXXVI.

Un&uous applications were very frequently employ-
ed in this difcafe by the ancients : and fome modern
practitioners have confidered them as very ufeful.
Their efFecls, however, have nor appeared to be con-
iiderablej and, as a weak auxiliary only, attended
with fome inconvenience, they have been very much
neglected by the Bntifh practitioners.
MCCLXXVII.

Bleeding has been formerly employed in this dif*
eafe ; but of late it has been found prejudicial, except-
ing in a few cafes, where, in plethoric habits, a fever
has fupcrvened. In general, the itate of men's bodies
in warm climates is unfavourable to t>lood-letting :
and, if we may form indications from the Hate of the
blood drawn out of the veins, the ftate of this in teta-
nic difeafes would forbid bleeding in them,
MCCLXXVHL

Bliftering alfo has been formerly employed in this
difeafe ; .but feveral practitioners ailert, that bliflers
are conftantly hurtful,, and they are now generally
omitted.

MCCLXXIX.

Thefe are the practices that hitherto have been ge-
nerally employed ; but of late we are informed by fe-
veral Weil India practitioners, that in many inflanccs
they have employed mercury with advantage. We
are told, that it rnuft be employed early in the dif-
eafe ; that it is moft conveniently adminillcred by
unction, and mould be applied in that way in large
quantities, fo that thebooy may be foon filled with it,
and a falivation raifed, which is to be continued till
the fymptoms yield. Whether this method alone be
generally fufficient for the cure of this difeafe, or if it
may be affided by the ufc of opium, and require this

iu

OF PHYSIC. 151

in a certain meafure to be joined with it, I have not
yet certainly learned.

MCCLXXX.

I have been further informed, that the tetanus, in
all its different degrees, has been cured by giving in-
ternally the Piflelaeum Barbadenfe, or, as it is vulgar-
ly called, the Barbadoes Tar. 1 think it proper to
take notice of this here, although I arnnot exactly in-
formed what quantities of this medicine are to be giv-
en, or in what circumitances of the difeafe it is moll
properly to be employed.

MCCLXXX.*

In the former edition of this work, among the reme-
dies of tetanus I did not mention the ufe of cold ba-
thing ; becaufe, though I had heard of this, I was net
informed of fuch frequent employment of it as might
confirm my opinion of its general efficacy : nor was I
fufficiently informed of the ordinary and proper ad-
miniftration of it. But now, from the information of
many judicious practitioners who have frequently em-
ployed it, I can fay, that it is a remedy which in_nu-
merous trials has been found to be of great fervice in
this difeafe; and that, while the ufe of the ambiguous
remedy of warm bathing is entirely laid afide, the ufe
of cold bathing is over the whole of the Weft Indies
commonly employed. The adminiftration of it is
fometimes by bathing the perfon in the fea, or more
frequently by throwing eold water from a bafon or
bucket upon the patient's body, and over the whole
of it : when this is done, the body is carefully wiped
dry, wrapped in blankets, and laid a-bed, and at the
fame time a large dofe of an opiate is given. By thefe
means a coniiderable remiflion of the fyrnptoms is ob-
tained ; but this remiflion, at firft, does not common-
ly remain long, but returning again in a few hours,

the

* The Paragraphs were thus numbered in the la ft edition.

i'5a PRACTICE

the repetition both of the bathing and the opiate be-
comes neceiTary. By thefe repetitions, however,
longer intervals of eafe are obtained, and at length the
difeafe is entirely cured ; mid this even happens fome-
tiraes very quickly. I have only to add, that it does
not appear to me, from any accounts that I have yet
had, that the cold bathing has been fo frequently em-
ployed, or has been Lund fo commonly fuccefsful in
the cafes or tetanus in confequence of wounds, as in
thofe from the application of cold.
MCCLXXXL

Before concluding this chapter, it is proper for me
to take fome notice of that peculiar cafe of the teta-
nus, or trifmus, which attacks certain infants ibon af-
ter their birth, and has been properly enough named
the Trifmus Nafcentium. From the fubjccls it af-
fects, it feems to be a peculiar difeafe : for thefe are
infants not above two weeks, and commonly before
they are nine days, old ; infomuch that, in countries
where the difeafe is frequent, if children pafs the peri-
od now mentioned, they are considered as fecure a-
gainft its attacks. The fymptom of it chiefly taken
notice of, is the trifmus, or locked jaw, which is by
the vulgar improperly named the Falling of the Jaw.
But this is not the only fymptom, as, for the mod part,
it has all the fame fymptoms as the Opifthotonos and
Tetanus ftiictly fo called, and which occur in the o-
ther varieties of the tetanic complaints above defcrib-
ed. Like the other varieties of tetanus, this is moil
frequent in warm climates, but it is not, like thole a-'
riling from the application of cold, entirely confined
to fuch warm climates, as iriftances of it have occur-
red in moil of the northern countries of Europe. In
thefe latter it feems to be more frequent in certain dif-
tricls than in others ; but in what manner limited, I
cannot determine. It feems to be more frequent
in Switzerland than in France. I am informed of its

frequently

O F P H Y S I C. 133

frequently occurring in the Highlands of Scotland ;
but I have never met with any initance oiit in the
low country. The particular caufes of it are not well
known ; and various conjectures have been offer-
ed ; but none of them are fatisfying. It is a dlfeafe
that has been aimoft conftantly fatal; and this, alfo,
commonly in the courfe of a few days. The women
are fo much perfuaded of its inevitable fatality, that
they feldom or never call for the affiflance of our art.
This has occalioned our being little acquainted with
the hiftory of the difeafe, or with the effects of reme-
dies in it. Analogy, however, would lead us to em-
ploy the fame remedies that have proved ufeful in the
other cafes of tetanus : and the few experiments that
are yet recorded, feem to approve of fuch a practice.

CHAP. II.

OF EPILEPSY.

MCCLXXXII.

IN what fenfe I ufe the term Convulfion, I have ex-
plained above in MCCLVI.

The convuliions that affect the human body are
in feveral refpects various ; but I am to confider here
only the chief and moft frequent form in which they
appear, and which is in the difeafe named Epilepfy.
This may be defined, as confiding in convulfions of
the greater part of the mufcles of voluntary motion,
attended with a lofs of fenfe, and ending in a Hate of
infenfibility and feeming fleep.

MCCLXXXIII.

The general form or principal circumflances of this
VOL. II. U difeafe,

354 PRACTICE

difeafe, are much the fame in all the different pen'
whom it affects. It comes by tits, which often attacks
perfons Jfecmingly in perfect health ; and, after lading
forfome time, pals off, and leave the perfons again in
theiitafual Rate. Thefe fits are fometimes preceded
by certain fymptoms, which to perfons who have be-
fore experienced fuch a fit, may give notice or its ap-
proach, as we fhall hereafter explain ; btit even thefe
preludes do not- commonly occur long before the for-
mal attack, which in moll cafes comes on fuddenly
without any fuch warning.

The per fen attacked lofes fuddenly all fen fe and
power of motion ; fo that, if {landing, he falls imme-
diately,, or perhaps, with convulfions, is thrown to
the ground. In that fituation he is agitated with vi-
olent convulfions, varioufly moving his limbs and the
trunk of his body* Commonly the Jimbs on one
fide of the body are more violently orfcore conflder-
ably agitated than thofe upon the orher. In all cafes
the mufcles of the face and eyes are much affected,
exhibiting various and violent diftortions of the coun-
tenance. The tongue is often affected, and thruft
out of the mouth ; while the mufcles of the lower jaw
are aifo affected ; and, {hutting the mouth with vio-
lence while the tongue is thruft out between the teeth,
that is often grievoufly wounded.

While thefe convulfions continue, there is common-
ly at the fame time a frothy moifture iffuing from the
mouth. Thefe convulfions have for fome moments
feme remiffions, but afe fuddenly again renewed with
great violence. Generally, after no long time, the
conviilliorrs 'cfeafe altogether; and the perfon for fome
time remains without motion, but in a ftate of abtb-
lute infeniibility, -and under the appearance of a pro-
found fleep. After fome continuance of this feeming
fieep, the perfon fometimcs'fuddenly, but for the moft
part by degrees only, recovers his fenies and power

of

O F P H Y S I C. 155

of motion ; but without any memory of what had pafT-
ed from hi? being firll ieized with the fit. Daring
the convulfions, the puUe and refpiration are hurried
and irregular; bat, when the conyulficns ceafe, they
return to their ufual regularity and healthy ftate.

This is the general form of the difeafe; and it va-
ries only in different perfons, or on different accafions
in the fame perfon, by the phe-nom-ena mentioned be-
ing more or Icfs violent, or by their being of longer or
Sorter duration.

MCCLXXXIV.

With refped: to the proximate caufe of this difeafe,^
I might fay, that it is an affection of the energy of the
brain, which, ordinarily under the direction of the
will, is here, without any concurrence of it, impelled
by preternatural caufes. But I could go no farther :
For, as to what is the mechanical condition of the
brain in the ordinary exertions of the will, I have no
diftindt knowledge ; and therefore mud be alfo igno-
rant of the preternatural ftate of the fame energy of
the brain under the irregular motions here produced.
To form, therefore, the indications of a cure, from a
knowledge of the proximate caufe of this difeafe, I
mull not attempt, but, from a diligent attention to
the remote caufrs which firft induce and occasionally
excite the difeafe, I think we may often obtain fome
ufeful directions for its cure; It mail therefore be my
bufinefs now, to point out and enumerate thefe re«
mote caufes as well as I can.

MCCLXXXV.

The remote caufes of epilepfy may be confidered as
occaiional or predifponent. There are, indeed, cer-
tain remote caufes w^hich acl independently of any
predifpofition ; but5 as we cannot always diilinguidi
thefe from the others, I fhall confider the whole under
the ufual titles o^Occafional or Predifponent.

U % MCCLXXXVI.

I56 PRACTICE

MCCLXXXVI.

The occafional caufes, may, I think, be properly re-
ferred to two general heads ; ihejir/t being of thofe
which feem to ad by directly ftimulating and exciting
the energy of the brain ; and the fecond, of thole
which feem to act by weakening the fame. With
refpect to both, for the brevity of expreffing a fact,
without meaning to explain the manner in which it
is brought about, I fliall life the terms of Excitement
and Collapfe. And though it be true, that with re-
fpcct to forne of the caufes I am to mention, it may be
a little uncertain whether they act in the one way or
the other, that does not render it improper for us to
mark, with refpect to others, the mode of their operat-
ing, wherever we can do it clearly, as the doing fa
may often be of ufe in directing our practice.
MCCLXXXV1I.

Firft, then, of the occafionai caufes acting by excite*
ment : They are either fuch as act immediately and
directly upon the brain itfelf ; or thofe which are firft
applied to the other parts of the body, and are from
thence communicated to die brain.
MCCLXXXV1II.

The caufes of excitement immediately and directly
applied to the brain, may be referred to the four heads
of, i. Mechanical Stimulants ; 2. Chemical Stimu-
lants; 3. Mental Stimulants; and 4. The peculiar
Stimulus of Over-diftention.

MCCLXXXIX.

The mechanical ftimulams may be, wounding in-
ftruments penetrating the cranium, and entering the
fubftance of the brain ; or fplinters of a fractured cra-
nium, operating in the fame manner; or iliarp-point-
ed oflifications, either arifing from the internal fin face
of the cranium, or formed in the membranes of the
brain.

MCCXC.

OF PHYSIC. 157

MCCXC.

The chemical {timulants (MCCLXXXVIII.) maybe
fluids from various caufcs lodged in certain parts of
the brain, and become acrid by ftagnution or other-
wife.

MCCXCI.

The mental irritations aduig by excitement, are,
all violent emotions of the adtive kind, fuch as joy
and anger. The firll of thefe is manueiuy an excit-
ing power, acting -ftrongly, and immediately, on the
energy of the brain. The fecond is manifeitiy, alfo,
a power acting in the fame manner. But it mull be
remarked, that it is not in this manner alone anger
produces its effects : for it ads, alfo, itrongly on the
fanguiferous fyitem, and may be a means of giving
the ftimulus of over-detention ; as, under a fit of an-
ger, the blood is impelled into the veifcls of the head
with violence, and in a larger quantity.
MCCXCII.

Under the head of Mental Irritations, is to be
mentioned, the fight of perfons in a fit of epilepfy,
which has often produced a fit of the like kind in the
fpectator. It may, indeed, be a quefdon, Whether
this effect be imputable to the horror produced by a
fight of the feemmgly painful agitations of the limbs,
and. of the distortions in the countenance of the epi-
leptic peifon; or if it may be afcribed to the force of
imitation merely ? It is pt>ilibie, that horror may fome-
times produce the effect : but cert -inly much rmy br*
imputed to that propenlity to imitation, at alt tirres
fo powerful and prevalent in human nature : and fi
often operating in other cafes of convuiiivc; difonleis,
which do not prefent any fpeclacle of horror.
MCCXCI1I.

Under the fame head of Mental Irritation, I think
proper to mention as an inftance of it, the Epilepiia
ta, or the Feigned Epilepfy, io often taken no-
tice

i5S PRACTICE

lice of. Although this, at the firft, may be entirely
feigned, I have no doubt but that the repetition ren-
ders it at lenrth ren:. The hiftory of Quietifrn and
of Exorcifms leads me to this opinion : and which
receives a confirmation from what we know of the
power of imagi nation, in renewing epileptic and hyfc
teric fits.

MCCXCIV.

I come now to the fourth head of th<5 irritations
applied immediately to the brain, and which I appre-
hend to be that of fhe over-dillenfion of the blood-
vcifcls in that organ. That fuch a caufe operates in
producing epilepfy, is probable from this? that the
difiedion of pcrfons dsad of epilepfy, has commonly
tliicovered the marks of a previous congeftion in the
blood-veusls of the brain. This, perhaps, may be
iuppoft'd the effect of the fit which proved fatal: but
that the ccngeftion wafc previous thereto, is probable
from the epilepfy being fo often joined with headach,
mania, prJfy, and apoplexy ; all of them difeafes de-
pending upon a coiigciiion in the veffels of the brain.
^ general opinion receives alfo confirmation from
circurnitance, that, in the brain of perfons dead
of 'epilepfy, there have beenoften found tumours and
Qoos; whicli, though feemingly not fufficient to
produce thofe difeafes which depend on the compref-
fion of a cjniiderable portion of the brain, may, how-
ever, have been fufficient to comprefs fo many velfels
:;s to render the others upon any oocalion of a more
than'ufual turgefcence, or impulfe of the blood into
the veiiels of the brain more liable to an over-diften-^
lion.

MCCXCV.

Thefe confiderations alone might afford foundation
for a probable conjecture with refpecl to the effeds of
over-diiteridon. But the opinion, does not reft upon
conjecture alone. Th.it it is alfo founded in facl, ap-
pears

OFF II Y S I C. 159

pears from hence, that a plethoric ftate is favourable
to epilepfy ; and that every occalional turgefcence,
or unufual impulfe of the blood into the veflels of the
brain, fuch as a fit of anger, the heat of the fun, or of
a warm chamber, violent exercife, a furfeit, or a fit of
intoxication, are frequently the immediate exciting
caufes of epileptic fits.

MGCXCVI.

I venture to remark further, that a piece of theory
may be admitted as a confirmation of this dodkine'.
As I have formerly maintained, that a certain fulnefs
and teniion of the velfels of the brain is neceflary to
the fupport of its ordinary and conftant energy, in
the diilributicn of the nervous power ; fo it mull be
fufficiently probable, that an over-diftenfion of thefe
blood- veflels may be a caufe of violent excitement.

MCCXCVIL

We have now enumerated the feveral remote or oc-
cafional caufes of epilepfy, acting by excitement, and
ading immediately upon the brain itfelf. Of the
caufe* a£ting by excitement, but acling upon other
parts of the body, and from thence communicated to
the brain, they are all of them impreflions producing
an exquifite or high degree either of pleafure or pain.
Impredions which produce neither the one nor the
other, have hardly any fuch effects, unlefs when fuch
impreflions are in a violent degree ; and then their
operation may be ccnfidered as a mode of pain. It is,
however, to be remarked, that all ftrong impreflions
which are fudden and furprifing, or, in other words,
unforefeen and unexpected, have frequently the effect
of bringing on epileptic fits.

MCCXCVIII.

There are certain impreflions made upon different
parts of the body, which as they often operate with-
out producing any fenfation, fo it is uncertain to what
head they belong ; but it is probable that the greater

part

160 PRACTICE

.part of them act by excitement, and therefore fall to
be mentioned here. The chief inftances are, The
teething of infants ; worms; acidity or other acrimo-
ny in the alimentary canal ; calculi in the kidneys ;
acrid matter in abfceffes or ulcers; or acrimony dif-
fufed in the rnafs of blood> as in the cafe of fome con-
tagions.

MCCXCIX.

Phyiicians have found no duliculty in comprehend-
ing how direct fliniulants, of a certain force, may ex-
cite the action of the brain, and occafion epilepfy :
but they have hitherto taken little notice of certain
caufes which manifestly weaken the energy of the
brain, and ad, as 1 ipeak, by collapfe. Thefe, how-
ever, have the effect of exciting the aclion of the brain
in fuch a manner as to occalion epilepfy. I might
upon this fubject, fpeak of the vis medicatrix natura ;
and there is a foundation for the term ; but, as I do
not admit the Stahiian dochine of adminiftering foul,
I make ule of the term only as expreffing a fa£t, and
\vould not employ it with the view of conveyiag an
explanation of the manner in which the powers of
collapfe mechanically produce their effects. In the
mean time, however, I maintain, that there are certain
powers of collapfe, which in cifecl: prove ftimulants,
and produce epilepfy.

MCCC.

That there are fuch powers, which may be termed
Indirect Stimulants, I conclude from hence, that feve-
ral of the caufes of epilepfy are fuch as frequently
produce fyncope, which we fuppofe always to depend
upon caufes weakening the energy of the brain, (MC-
LXXVI.) Ir may give fome difficulty to explain, why
the fame caufe fometimes occafion fyncope, and fome-
times bccaiion the reaction that appears in epilepfy ;
and I (hall not attempt to explain it: but this, I think,
dues not prevent my ftrppofing that the operation of

thefe

<XF PHYSIC. 161

thefe caufes is by collapfe. That there are fuch'caufes
producing epilepfy, will, I think, appear very clearly
from the particular examples of them I am now to
mention.

MCCCI.

The ftrft to be mentioned, which I fuppofe to be
df this kind, is hemorrhagy, whether fpontaneous or
artificial. That the fame hemorrhagy whieh produc-
es fyncope, often at the fame time produces epilepiy,
is well known ; and from many experiments and ob-
fervations it appears, that hemerrhagies occurring to
fuch a degree as to prove mortal, feldom do fo with-
out firlt producing epilepfy.

MCCCII.

Another caufe acting, I fuppofe, by collapfe, and
therefore fometimes producing fyncope, and fometimes
epilepfy, is terror ; that is, the fear of fome great evil
fuddenly prefented. As this produces at the fame
time a fudden and considerable emotion, (MCLXXX.)
fo h more frequently produces epilepfy than fyncope.
MCCGIIL

A third caufe acting by collapfe, and producing
epilepfy, is horror ; or a ftrong averfion fuddenly raid-
ed by a very difagreeable fenfation, and frequently
arifing from a fympathy with the pain or danger of
another perfon. As horror is often a caufe of fyncope,
there can be no doubt of its manner of operating in
producing epilepfy ; and it may perhaps be explain-
ed upon this general principle, That as defire excites
action and gives activity, fo averiion reflrains from
action, that is, weakens the energy of the brain; and,
therefore, that the higher degrees of averfion may
have the effects of producing fyncope or epilepfy.
MCCCIV.

A fourth fet of the caufes of epilepfy, which I fup-
pofe alfoto act by collapfe, are' certain odours, which
occaiion either fyncope or epikpfy ; and, with refpect

VOL. II. X to

162 PRACTICE

to the former, I have given my reafons (MCLXXXII.)
for fuppofing odours in that cafe to act rather as difa-
greeable than as fedativc. Thefe reafons will, I think,
alfo apply here ; and perhaps the whole affair of odours
might be coniidered as inftances of the effect of hor-
ror, and therefore belonging to the laft head.

MCCCV.

A fifth head of the caufes producing epilepfy by
collapfe, is the operation of many fubftances conii-
dered, and for the moil part properly confidered, as
poifons. Many of thefe, before they prove mortal,
occafion epilepfy .• This effect, indeed, may in fome
cafes be referred to the inflammatory operation which
they fometimes difcover in the ftomach, and other
parts of the alimentary canal ; but, as the greater part
of the vegetable poifons fhow chiefly a narcotic, or
ftrongly fedative power, it is probably by this power
that they produce epilepfy, and therefore belong to
this head of the caufes acting by collapfe.

MCCCVI.

Under the head of the remote caufes producing
epilepfy5 we mud now mention that peculiar one
whofe operation is accompanied with what is called
the Aura Epikptica. This is a -fenfation of fomething
moving in fome part of the limbs or trunk of the bo-
dy, and from thence creeping upwards to the head ;
and when it arrives there, the perfon is immediately
deprived ot fenfe, and falls into an epileptic fit. This
motion is defcribed by the perfons feeling it fome-
times as a cold vapour, fometimes as a fluid gliding,
and fometimes as the fenfe of a fmall infect creeping
along their body ; and very often they can give no
diitinct idea of their fenfation, otherwife than as in
general of fomething moving along. This fenfation
might be fuppofed to arife from one affection of the
extremity or other part of a nerve acted upon by fome
•irritating matter ; and tint the fenfation, therefore,

fot

OF PHYSIC. 163

followed the courfe of iuch a nerve : but I have never
found it following diftinctly the courfe of any nerve ;
and it generally feems to pafs along the teguments,
It has been found in fome inftances to arife fro in
fomething preffing- upon or irritating a particular
nerve, and that fometimes in confequencc of contuli-
on or wound : but inftances of thefe are more rare ;
and the more common confequences of contuiions and
wounds is a tetanus. This latter effect wounds pro-
duce, without giving any fenfation of an aura or other
kind of motion proceeding from the wounded part to
the head ; while, on the other hand, the aura produ-
cing epilepfy often arifes from a part which never
had been affected with wound or contufion, and in
which part the nature of the irritation can feldom be
difcovered.

It is natural to imagine that this aura epileptica is
an evidence of fome irritation or direct flimulus acting
in the part, and from thence communicated to the
brain, and mould therefore have been mentioned a-
mong the caufes acting by excitement ; but the re-
markable difference that occurs in feemingly like
caufes producing tetanus, gives fome doubt on this
fubject.

MCCCVII.

Having now enumerated the occafional caufes of
epilepfy, I proceed to confider the predifponent. As
fo many of the above-mentioned caufes act upon cer-
tain perfons, and not at all upon others, there mud be
fuppofed in thofe perfons a predifpofition to this dif-
eafe : But in what this predifpoiitioa confifls, is not
to be ealily afcertained.

MCCCVIII.

As many of the occafional caufes are weak imprcf-
fions, and are applied to moft perfons with little or no:
effect, I conclude, that the perfons affected by thofe
caufes are more eafily moved than others ; and there-

X 2 fore

164 PRACTICE

fore that, in this cafe, a certain mobility gives the
predifpofition. It will,- perhaps, make this matter
clearer, to mow, in the firft place, that there is a
greater mobility of conftitution in fome perfons than
in others.

MGCCIX.

This mobility appears molt clearly in the flare of
the mind. If a perfon is readily elated by hope, and
as readily dcpreffed by fear, and pafies eaiily and
quickly from one ftate to the other ; if he is eafily
pleafed, and prone to gaiety, and as eaiily provoked
to anger, and rendered peevifh ; if liable, from flight
impreffions, to ftrong emotions, but tenacious of none ;
this is the boyifh temperament qui c'Mgit ac ponit
iram temere^ et muiatur in horas ; this is the variwn et
mutabile fcemina ; and, both in the boy and woman,
every one perceives and acknowledges a mobility of
mind. But this is neceflarily connected with an an-
alogous ftate of the brain ; that is, with a mobility, in
refpecl of every imprefiion, and therefore liable to a
ready alteration of excitement and collapfe, and of
both to a considerable degree.
MCCCX.

There is, therefore, in certain perfons, a mobility
of conftitution, generally derived from the ftate of o-
rigintl ftamlna, and more exquiiite at a certain period
of life than at others ; but fometimes arifingfrom, and
particularly modified by, occurrences in the courfe
of life.

MCCCXI.

This mobility conlifts in a greater degree of either
feniibility or irritability. Thefe conditions, indeed,
phyficians confider as fo neccrTarily connected, that
the conftitution with refpect to them, may be confider-
ed as one and the fame : but I am of opinion that
they are different ; and that mobility may fometimes
Depend upon an increafe of the one', and fometimes

O F P H Y S I C. 165

on that of the other. If an a&ion excited, is, by re-
petition rendered more caiily excited, and more vigo-
rouily performed, I confider this as anincreafe of irri-
tability only. I go no farther on this fubieet here, as
it was only neceifary to take notice of the cafe juil
now mentioned, for the purpofe of explaining why
epilepfy, and convullions of all kinds, by being repeat-
ed, are more eaiily excited, readily become habitual,
and are therefore of more difficult cure.
MCGCXII.

However we may apply the diilinclion of fenfibili-
ty and irritability, it appears that the mobility, which
is the predifponent cauie of epilepfy, depends more
particularly upon debility 3 or upon a plethoric ilate
of the body.

MCCCXIII.

What fhare debility, perhaps by inducing fenfibi-

lity, has in this matter, appears clearly from hence,

that children, women, and other perfons of man if eft

debility, are the mod frequent fubjacts of this difeafe.

MCCC.XIV.

The effects of a plethoric ilate in difpofing to this
difeafe appears from hence, that plethoric perfons are
frequently the fubjects of it : that it is commonly ex-
cited, as I have faid above, by the caufes of any unu-
i'ual turgefcence of the blood ; and that it has been
frequently cured by diminithing the plethoric ilate of
the body.

That a plethoric ftate of the body fhould difpofa
to this difeafe, we may underlland from feveral con-
iiderations. ift, Becaufe a plethoric Rate implies,
for the moft part a laxity of the folids, and therefore
fome debility in the moving fibres. 2tv/y, Becaufe,
in a plethoric ftate, the tone of the moving fibres de-
pends more upon their tenficn, than upon their inhe-
rent power : and as their tenfion depends upon the
Quantity and impetus of the fluid in the blood- vefiels,

which

i66 PRACTICE

which are very changeable, and by many caufes fre-
quently changed, fo thefe frequent changes muft give
a mobility to the fyftem. $dfy9 Becaufe a plethoric
ftate is favourable to a congestion of blood in the
veflels of the brain, it muft render thefe more readily
affected by every general turgefcence of blood in the
fyftem, and therefore more efpecially difpofe to this
difeafe.

MCCCXV.

There is another circumftance of the body difpof-
ing to epilepfy, which I cannot fo well account for :
and that is, the Mate of fleep : but whether I can ac-
count for it or not, it appears, in fact, that this ftate
gives the difpofition Ifpeak of; for, in many perfons li-
able to this difeafe, the fits happen only in the time
of fleep, or immediately upon theperfon's coming out
of it. In a cafe related by De Haen, it appeared clear-
ly, that the difpofidon to epilepfy depended entirely
upon the ilate of the body in fleep*.
MCCCXVL

Having thus considered the whole of the remote
caufes of epilepfy, I proceed to treat of its cure, as I
have faid it is from the confederation of thofe remote
caufes only that we can obtain any directions for our
practice in the difeafe f.

I be-

* This was a very fingular cafe. The chief circum Ranees in it
were, that the boy was more liable to the paroxyfms when lying and
afleep, than when fitting up and awake. This peculiarity was not
obfervedtill the difeufe had been of fome ftanding, and, on a more
minute attention, the paroxyfms were found to be more frequent
when the patient was in a peculiar ttate of fleeping, namely, when
he was drowfy, or when he fnored in his fleep, than when he enjoy-
ed an eafy and quiet fleep. A natural, quiet, and eafy fleep, was
procured by the ufe of opium ; and in a {hort time, the difeafe was
perfectly cured ; but the boy died afterwards in confcquence of a
tumor in his groin.

•j* Other caufes of Epilepfy are enumerated by medical writers,
which the author, for the fake of brevity, left unnoticed.

OF PHYSIC. 167

I begin with obfervmg, that as the difeafe may be
confidered as fympathic or idiopathic, I muft: treat of
thefe feparately, and judge it proper to begin with the
former.

MCCCXVII.

When this difeafe is truly fympathic, and depend-
ing upon a primary affection in feme other part of the
body, fuch as acidity or worms in the alimentary ca-
nal, teething, or other fimilar caufes, it is obvious that
fuch primary affedions muft be removed for the
cure of the epilepfy ; but it is not our bufinds here
to fay how thefe primary difeafes are to be treated.
MCCCXVIII.

There is, however, a peculiar- cafe of fympathic
epilepfy; that is, the cafe accompanied with the au-
ra

Cafes have occurred in whicn the epilepfy feems to have proceed-
ed from an hereditary taint.

Quickfilver, either accidentally or intentionally applied, has
been frequently found to produce epilepfy. Perfons employed in
gilding of metals are often feized with tremblings of the hands, with
palfy ,and with epilepfy, which can be attributed to nothing elfe than
the abforption of the vapours of mercury nfed in the operation, which
is as follows : the piece of metal to be gilt is firft well cleaned and po-
lluted ; fome mercury fhaken with aqua fortis is fpread upon it, till
the furface appears- all over as white as iilycr : being then heated and
le-touched in thole parts that have efcaped the mixture, an amalga-
ma of mercury and gold is laid on it ; the heat foftening the amal-
gama, makes it fpread more uniformly ; and the intervention of the
mercury and aqua fortis makes it adhere more firmly. The piece
thus covered with the amalgama is placed on a convenient fupport,
over a charcoal fire ; and examined, from time to time, as the mer-
cury evaporates, that, if any deficiencies appear, they may be fuppli-
ed with a little more of the amalgama before the operation is com-
pleted. This procefs necefiarily expofes the artift to the fumes of
the mercury.

Van Swieten fays that he has feen fkulls, in the dipploe of which
globules of mercury manifeftly appeared j and he thinks it probable
that the mercury may pofiibly be thrown out into the cavities of the
brain itfelf, and produce much mifchief.

Venery, when exceflive, has been enumerated among the caufes
of epilepfy by Bocrhaave,but on what authority feems uncertain.

i68 PRACTICE

ra epileptica, as uefcribed in MCCCVI, in which, though
we can perceive by the aura epileptica urifing from a
particular part, that there is feme affection in that
part ; yet, as in many fuch cafes we cannot perceive of
\vhat nature the affedion is, I can only offer the fol-
io wing general directions.

17?. When the part can with fafety be entirely de-
ftroyecl, we fhould endeavour to do fo by cutting it
out, or by defhoying it by the application of an actual
or potential cautery.

2*//y, When the part cannot properly be deflroyed,
that we fhould endeavour to correct the morbid affec-
tion in it by bliitcring, or by eflablifhing aniffuc up-
on the part,;

3^/X, When thefe mesfures cannot be executed, or
do not fucceed, if the difeafe feems to proceed from
the extremity of a particular nerve which we can eafi-
ly come at in its courfe, it will be proper to cut through
that nerve, as before propofed on the fubject of teta-
nus.

4tbty9 When it cannot be perceired that the aura
arifcs from any precife place or point, fo as to direct
to the above-mentioned operations ; but, at the fame
time, we can perceive its progrcis along the limb ; it
frequently happens that the epilepfy can be prevented
by a ligature applied upon the limb, above the part
from which the aura arifes : and this is always proper
to be done, both becaufe the preventing a fit breaks
the habit of the difeafe, and becaufe the frequent com-
preflion renders the nerves lefs fit to propagate the
aura.

MCCCX1X,

The cure of idiopathic epilepfy, as I have faid a-
bove, is to be directed by our knowledge of the remote
caufes. There are therefore two general indications
to be formed : The firft is, to avoid the occailonal cauf-
es ; and the fecond is, to remove or correct the pre-
difponent. This

OF PHYSIC. 169

This method, however, is not always purely palli-
ative ; as in many cafes the prcdifponent may be
confidered as the only proximate caufe, fo our fecond
indication may be often coniidered as properly cura-
tive.

MCCCXX.

From the enumeration given above, it will be mani-
feft, that for the moft part the occafional caufes, fo
far as they are in our power, need only to be known,
in order to be avoided ; and the means of doing this
will be fufficiently obvious. I mall here, therefore,
offer only a few remarks.

MCCCXXI.

One of the mod frequent of the occafional caufes is
that of over-diftenfion, (MCGCXIV.) which, fo far as it
depends upon a plethoric ftate of the fyftem, I mall
fay hereafter how it is to be avoided. But as, not
only in the plethoric, but in every moveable conftitu-
tion, occafional turgefcence is a frequent means of ex-
citing epilepff, the avoiding therefore of fuch turgef-
cence is what ought to be mofl conflantly the object
of attention to perfons liable to epilepfy.
MCCCXXII.

Another of the mofl frequent exciting caufes of this
difeafe are, all flrong impreflions fuddenly made upon
the fenfes ; for as fuch impreflions, in moveable confti-
tutions, break in upon the ufual force, velocity, and
order of the motions of the nervous fyftem, they there-
by readily produce epilepfy. Such impreffions, there-
fore, and efpecially thofe which are fuited to excite
any emotion or paffion of the mind, are to be mofl
carefully guarded againfl by perfons liable to epilep-
fy.

MCCCXXIII.

In many cafes of epilepfy, where the predifponent
caufe cannot be corrected or removed, the recurrence
of the difeafe can only be prevented by the flricleft at-

VOL. II. Y tention

170 P R A C T I C E

tention to avoid the occafional; and as the difeafe is of-
ten confirmed by repetition and habit, fo the avoiding
the frequent recurrence of it is of the utmoft import-
ance towards its cure.

Thefe are the few remarks I have to offer with re-
fpecl: to the occasional caufes ; and muft now obferve
that, for the moil part, the complete, or, as it is called,
the Radical Cure, is only to be obtained by removing
or correcting the predifponent caufe.
MCCCXXIV.

I have faid above;, that the predifponent caufe of
epilcpfy is a certain mobility of the fenforium ; and
that this depends upon a plethoric ftate of the fyftem,
or upon a certain flate of debility in it.
MCGCXXV.

How the plethoric flute of the fyflem is to be cor-
rected, I have treated of fully above in DCCLXXXIII.
€t feq. and I need not repeat it here. It will be enough
to fay, that it is chiefly to be done by a proper ma-
nagement of exercife and diet ; and, with refpeci: to
the latter, it is particularly to be obferved here, that
an abflernious courfc has been frequently found to be
the mod certain means of curing epilepfy.
MCCCXXVI.

Confidering the nature of the matter poured out
by iffues, thefe may be fuppofcd to be a conftant
means of obviating the plethoric ftate of the fyftem ;
and it is, perhaps, therefore, that they have been fo oft-
en found ufeful in epilepfy. Poffibly, alfo, as an open
iflue may be a means of determining occafional tur-
gefcences to fuch places, and therefore of diverting
them in feme raeafure from their adion on the brain ;
fo alfo, in this manner, iiTues may be ufeful in epi-
lepfy.

MCCCXXVII.

It might be fuppofed that blood-letting would be
the moil effectual means of correcting the plethoric

ftati

OF PHYSIC, 171

ftate of the fyflem ; and fuch it certainly proves when
the plethoric fiate has become coniiderable, and imme-
dia ely threatens morbid effects. It is therefore, in fuch
circumftances, proper and neceflary : but as we have
faid above, that blood-letting is not the proper means
of obviating a recurrence of the plethoric Rate, and,
on the contrary, is often the means of favouring it ;
fo it is not a remedy advifable in every circumltance
of epiiepfy. There is, however, a cafe of epilepfy in
which there is a periodical or occafiotial recurrence
of the fulnefs and turgefcence of the fanguiferous
fyftem, giving occalion to a recurrence of the difeafe.
In inch cafes, when the means of preventing plethora
have been neglected, or may have proved ineffectual,
it is abfolutrly neceflliry for the practitioner to watch
the returns of thele tu.gefcrnces, and to obviate their
cfFedls by the only certain means of doing it, thai is}
by a large blood-letting.

MCCGXXVIIL

The fecond caufe or mobility which we have ailigntr
ed, is a flare of debility. If this is owing, as it fre-
quently is, to original conformation, it is perhaps not
poiiible to cure it; but when it has beten brought on
in the courfe of life, it poilibiy may admit of being
mended • and, in either cafe, much may be done to
obviate and prevent its effects.

MCCCXXIX.

The means of correcting debility, fofar as it can be
done, are, The perfon's being much in cool air ; the
frequent ufe of cold bathing; the ufe of exercife, ar
dapted to the ftrength and habits of the perfon ; and,
perhaps, the ufe of aftringent and conic medicines.

Thcfe remedies arefuited to ftrengthen the inherent
power of the folids or moving fibres : but as the
ftrength of thefe depends alfo upon their tention,
fo when deoiiiiy has proceeded from inanition, the
ftrength may be reflored, by reftoring the fulnefs and

Y 2 ' tenfioa

PRACTICE

tenfion of the veflels by a nourifhing diet ; and we
have had inftances of the propriety and fuccefs of
fuch a practice.

MCCCXXX.

The means of obviating the effects of debility, and
of the mobility depending upon it^ are the ufe of to-,
nic and antifpafmodic remedies.

The tonics are, Fear, or fome danger of terror ; af-
tringents ; certain vegetable and metallic tonics ; and
cold bathing.

MCCCXXXI.

That fear, or fome degree of terror, may be of ufe
In preventing epilepfy, we have a remarkable proof
in Boerhaave's cure of the epilepfy, which happened
in the Orphan-houfc at Haerlem. See Kauu Boer-
haave's treatife, intitled Impetum Fociens, § 406.
And we have met with feveral other inftances of the
fame.

As the operation of horror is in many refpe&s an-
alogous to that of terror, feveral feemingly fuperftiti-
ous remedies have been employed for the cure of e-
pilepfy; and, if they have ever been fuccefsful, I
think it muft be imputed to the horror they had in-
fpircd*.

MCCCXXXII.

Of the aflringent medicines ufed for the cure of e-
pilepfy, the moil celebrated is the vifcus quercinus^
which, when given in large quantities, may pollibly
be ufeful ; but I believe it was more efpecially fo in
ancient times, when it was an object of iuperflition.

In

* Drinking a draught of the blood of a gladiator jiift killed ;
drinking a draught of water with a toad at the bottom of the jug ;
eating a piece of human liver, or the marrow of the bones of the leg
of a malefactor ; powder of the human fkull, or the mofs that grows
on it ; with a variety of fuch abominable remedies, were formerly
in great repute ; and indeed fome of them arc flill retained in feveral
foreign Pharmacopoeias.

OF PHYSIC, 173

In the few inftances in which I have feen it employed,
ic did not prove of any effect*.

MCCCXXXIII.

Among the vegetable tonics, the bitters are to be
reckoned ; and it is by this quality that I fu^ofe the
orange-tree leaves to have been uieful : but they are
not always fo.

MCCCXXXIV.

The vegetable tonic, which from its ufe in analogous
cafes is the moil promiiing, is the Peruvian bark;
this, upon occaiion, has been ufeful, but has alfo often
failed. It is efpecially adapted to thole epilepiies.
which recur at certain periods, and which are at the
fame time without the recurrence of any plethoric
Hate, or turgefcence of the blood ; and in fuch peri-
odical cafes, if the bark is employed fome time before
the expedled recurrence, it may be ufeful ; but. it niuli
be given in large quantity, and as near to the time of
the expected return as pofiible.

MCCCXXXV.

The metallic tonics feem to be more powerful than
the vegetable, and a great variety of the former have
been employed.

Even arfenic has been employed in the cure of epi-
lepfy ; and its ufe in intermittent fevers gives an analo-
gy in its favour.

Preparations of tin have been formerly recommend-
ed in the cure of epilepfy, and in the cure of the ana-
logous difeafe of hyfteria ; and feveral confideraiions
renders the virtues of tin, with relpecl: to thefe difeaf-
es, probable : but I have had no experience of its ufe
in fuch cafes.

A much fafer metallic tonic is to be found in the
preparations of iron ; and we have feen fome of them

employed

* The dofe of it was from half a drachm to a drachm in po\v..
an ounce in infufion.

174 PRACTICE

employed in the cure of epilepfy, but have never
found them to be effectual. This, however, I think,
may be imputed to their not having been always em-
ployed in the circumttances of the difeale, and in the
quantities of the medicine, that were proper and ne-
ceilary*.

MCCCXXXVI.

Of the metallic tonics, the molt celebrated and the
moft frequently employed is copper, under various
preparation. What preparation of it may be the
in oft effectual, I dare not determine ; but of late the
cuprum ammoniacum has been frequently found fuccefs-
fulf.

MCCCXXXVIL

Lately the flowers of zinc have been recommended
by a great authority as ufeful in all convulflve diibr-
ders ; but in cafes of epilepfy, I have not hitherto
found that medicine ufeful J.

MCCCXXXVIIL

There have been of late fome inftances of the cure
of epilepfy by the accidental ufe of mercury ; and if
the late accounts of the cure of tetanus by this reme-
dy are confirmed, it will allow us to .think that the
fame may be adapted alfo to the cure of certain cafes
cf epilepfy.

MCCCXXXIX.

* The method of ufing iron, was defcribed in a note on article

f This was a favourite remedy of the Author's. He fir A; intro-
duced it into practice in this country, and the preparation of it was
infer ted in the Edinburgh Pharmacopoeia.

It is employed by beginning with imall dofes of half a grain, and
increasing them gradually to as much as the ftomach will bear. It
is, however, like all preparations of copper, a very dangerous medi-
cine, and ought to be ufed with caution.

t The great authority by which the flowers of zinc were recom-
mended was Gaubius. It is as dangerous a medicine as the cuprum
ammoniacum, and mult be ufed with the fame caution.

OF PHYSIC. 175

MCCCXXXIX.

With refpect to the employment of any of the a-
bove mentigned tonics in this difeafe, it mud be ob-
ferved, that in all cafes where the difeafe depends up-
on a conftant or occafional plethoric ftate of the fyf-
tem, thefe remedies are likely to be ineffectual ; and
if fufficient evacuations are not made at the fame time,
thefe medicines are likely to be very hurtful.
MCCCXL.

The other fct of medicines which we have mention-
ed as fuited to obviate the effects of the too great mo-
bility of the fyilem, are the medicines named antif-
pafmodics. Of thefe there is a long lift in the writers
on the Materia Medica, and by thefe authors re-
commended for the cure of epilepfy. The greater
part, however, of thofe taken from the vegetable king-
dom, are manifeflly inert and infignirlcant*. Even,
the root of the wild valerian hardly fupports its cre-
dit.

MCGCXLI.

Certain fubftances taken from the animal kingdom
feem to be much more powerful : and of thefe the
chief, and feemingly the moft powerful, is mtifk ;
which, employed in its genuine ft ate, and in due quan-
tity, has often been an effectual remedy f.

It

* This is certainly true ; but it mud be acknowledged that Tome
of them are manifeftly active and ufeful, as the affafcetida, fagapenum,
and other foetid gums. Thepilulae gummofae of the Pharmacopoeia's,
are good formulae for thefe naufcous medicines ; and their being1 re-
puted inefficacious and infignificant feems to have arifen from their
not having been given in fufficiently large dofes. They may be given
with fafety to the quantity of two drachms in a day in repeated dofes
of twenty or thirty grains each ; and, if they mould happen to purge,
this inconvenience may be prevented, by adding- a quarter or half
a grain of opium to each dofe of the pills, or taking ten drops of
laudanum after each dofe, as occafion may require.

f Muflc is more effectual when given in fubftance, thnn in any
preparation that has been attempted ; it is given in dofes of from ten

176 PRACTICE

It is probable alfo, that the oleum animale, as it has
been named, when in its pureft itate, and exhibited at
a proper time, may be an effectual remedy*.
JVICCCXLIL

In many difeafes, the mod powerful antifpafmodic
is certainly opium; but the propriety of its ufe in epi-
lepfy has been difputcd among phyficians. When
the difeafe depends upon a plethoric ftate in which
bleeding may be neceilary, the employment of opium
is likely to be very hurtful : but, when there is no
plethoric or inflammatory ftate prefent, and the difeafe
feems to depend upon irritation or upon increafed irri-
tability, opium is likely to prove the mo ft certain re-
medyf. Whatever effects in this and other convul-
live difordsrs have been attributed to the hyofcyamus,
muft probably be attributed to its polTeffing a narcotic
power fimilar to that of opium.

MCCCXLIII.

With refpeft to the ufe of antifpamodics, it is to be
obferved, that they are always moft ufeful, and per-
haps only ufeful, when employed at a time when epi-
leptic fits are frequently recurring, or near to the

times

to thirty grains, and frequently repeated. It may be made Into a
bolus, as in the formula :

&. Mofch. gr. xv.

Tere in mortar, marmor. cum

Sacch. alb. 9i. et adde

Ccnfeft. cardiac, ^is.

M. f. bolus.
This bolus may be repeated three or four times a day.

* The dofe of this oil is from twenty to thirty drops ; it is, how-
ever, fcldom ufed.

f In thofe cafes, in which forne peculiar fymptoms indicate the
approach of the, fit, opium taken iu a large dofe has fometimes pre-
vented it altogether ; but molt commonly, however, fuch a dofe
greatly Icffens its violence. Two grains of opium in fubftance, or
fixty or fcventy drops of laudanum, are large dofe's.

O F P H Y S I C. 177

times of the acceffion of fits which recur after confi-
derable intervals.

MCCCXLIV.

On the fubject of the cure of epiiepfy, I have only
to add, that as the difeafe in many cafe* is continued
by the power of habit only, and that in all cafes habit
has a great fhare in increafing mobility, and therefore
in continuing this difeafe ; fo the breaking in upon
fuch habit, and changing the whole habits of the fyf-
tern, is likely to be a powerful remedy in epiiepfy.
Accordingly, a confiderable change of climate, diet,
and other circumftances in the manner of life, has
often proved a cure of this difeafe*.
MCCCXLV.

After treating of epiiepfy, I might here treat of
particular convullions, which are to be difiinguifhed
from epiiepfy by their being more partial: that is,
affecting certain parts of the body only, and by their,
hot being attended with a lofs of fenfe, nor ending in
fuch a comatofe ftate as epiiepfy always does.
MCCCXLVI.

Of fuch convulfive affections many different inftan-
ces have been obferved and recorded by phylicians.
But many of theie have been manifeftly fympathic af-

VOL. II. Z fedions,

* After all that has been faid on this difeafe, we mud acknow-.
kdge that we know but little of its true nature, and confequently no
certain method of eure can be given. It has baffled the fkill of phy-
licians from the earlieft ages of phyfic, and dill remains to be one of
thofe many difeafes which we cannot certainly cure.
: Some fpecies of it, indeed, are certainly curable ; but thefe are
few, and fuch only as are fymptomatic, or arife from peculiar me-
chanical irritations.

Experience has moreover fhevvn us, that the difeafe often esdfts
without any apparent irritation, and without any caufe obfervable on
diffecliioii. Much room is therefore left for future inveiligations on
this dark fubje& ; and we muil at prefent content ourfelves with the
hopesthat time will unfold >yh»t human ingenuity has not been capa-
ble of effecting.

i7S PRACTICE

fections, to be cured only by curing the primary dife
eafe upon which they depend, and therefore not to be
treated of here : Or, though they are fuch as cannot
be referred to another difeafe, as many of them, how-
ever, have not any fpecific character with which they
occur in different perfons, 1 mud therefore leave them
to be treated upon the general principles I have laid
down with refpect to epilepfy, or {hall lay down with
refpect to the following convulfive diibrder ; which as
having very conftantly in different perfons a peculiar
character, I think neceffary to treat of more particu-
larly.

C H A P. III.

OF THE CHOREA OR DANCE OF ST. VITUS*

MCCCXLVII.

THIS difeafc affects both fexes, and almoft only
young perfons. It generally happens from the
age often to that of fourteen years*. Itcomes on al-
ways before the age of puberty, and rarely continues
beyond that period.

MCCCXLVI1I.

It is chiefly marked by convulfive motions, fome-
what varied in different perfons, but nearly of one
kind in all ; affecting the leg and arm on the fame
fide, and generally on one fide only,

MCCCXLIX.

Thefe convulfive motions commonly firlt affect the

leg

* I have feen it in a robuft man of forty-two. This patient, after
various inefTedtual remedies had been ufed, was cured by ftrong elec-
trical fhocks directed through the whole body.

OF PHYSIC. 179

leg and foot. Though the limb be at reft, the foot
is often agitated by convulfive motions, turning it al-
ternately outwards and inwards. When walking is
attempted, the affected leg is feldom lifted as ufuai in
walking, but is dragged along as if the whole limb
were paralytic ; and when it is attempted to be lifted,
this motion is unfteadily performed, the limb .becom-
ing agitated by irregular convulfive motions.
MCCCL.

The arm of the fame fide is generally affected at
the fame time ; and, even when no voluntary motion,
is attempted, the arm is frequently agitated with vari-
ous convulfive motions. But efpecially when volun-
tary motions are attempted, thefe are not properly ex-
ecuted, but are varioufly hurried or interrupted by
convulfive motions in a direction contrary to that in-
tended. The mod common inftance of this is in the
perfon's attempting to carry*:a cup of liquor to his
rnouth, when it is only after repeated efforts, interrupt-
ed by frequent convulfive retractions and deviati-
ons, that the cup can be carried to the mouth.
MCCCL I.

It appears to me, that the will often yields to thefe
convulfive motions, as to a propenfity, and thereby
they are often increafed, while the perfon affected
feems pleafed with increaiing the furprife and amufe-
rnent which his motions occaiion in the byilanders.
MCCCLIL

In this difeafe the mind is often affected with fome
degree of fatuity ; and often {hows the lame varied,
defultory, and caufelefs emotions which occur in hy-
steria.

MGCCLIII.

Thefe are the mo ft ctrmmon circumftances of this
difeafe ; but at times, and in different perfons, it is
varied by fome difference in the convulfive motions,
particularly by thefe affecting the tread and trunk of

Z 2 the

iSo PRACTICE

the body. As in this difeafc there feem to be pro-
penfities to motion, fo various fits of leaping and run-
ning occur in the perfons affected ; and there have
been inftances of this difcafe, confiding of fuch con-
vulfive motions, appearing as an epidemic in a certain
corner of the country. In fuch inftances, perfons of
different ages are affected, and may feem to make an
exception to the general rule above laid1 down ; but
Hill the perfons are, for the moil part, the young of
both fexes, and of the more manifestly moveable con-
Hitutions.

MCCCLIV.

The method of curing this difcafe has been variouf-
ly propofed. Dr. Sydenham propofed to cure it by-
alternate bleeding and purging. In fome plethoric
habits I have found fome bleeding ufeful ; but in ma-
ny cafes I have found repeated evacuations, eipecially
by bleeding, very hurtful.

In many cafes, 1 have found the difeafe, in fpite of
remedies of all kinds, continue for many months ; but
I have alfo found it readily yield to tonic remedies, fuch
<is the Peruvian bark, and chalybeates.

The late Dr, De Haen found feveral perfons labour-
ing under this difeafe cured by the application of elec-
tricity.

SECT.

OF P H Y.S I a 18*

SECT. II.

OF THE SPASMODIC AFFECTIONS OF THE
VITAL FUNCTIONS.

CHAP. IV \.

OF THE PALPITATION OF THE HEART.
MCCCLV.

THE motion thus named is a contraction or fyf-
tole of the heart, that is performed with more
rapidity, and generally alfo with more force than ufu-
al ; and when at the fame time the heart ilrikcs with
more than ufual violence agatnft the infide of the ribs,
producing often a coniiderable found.

MCCCLVI.

This motion or palpitation, is cccafioned by a great
variety of caufes, which have been recited with great
pains by Mr. Scnac and others ; whom however, I
cannot follow in all the particulars with fufficient dif-
cernment, and therefore fhall here only attempt to re-
fer all the feveral cafes of this difeafe to a few general
heads.

MCCCLVII.

The fir ft is of thofe arifing from the application of the
ufual flimulus to the heart's contraction ; that is, the
influx of the venous blood into its cavities, being made
with more velocity, and therefore, in the fame time,
in greater quantity than ufual. It feems to be in this
manner that violent exercife occafions palpitation.

MCCCLVIII.

A fecond head of the cafes of palpitation, is of thofe
arifing from any refiftance given to the free and entire
evacuation of the ventricles of the heart. Thus a li-
gature

f Though I have thought it proper to divide this book into fec-
tions, I think it ncceflary, for the convenience of references, to num-
ber the chapteri from the beginning.

183 PRACTICE

gaturc made upon the aorta occafions palpitations of
the moll violent kind. Similar refinances, either in
the aorta or pulmonary artery, may be readily imagin-
ed ; and fuch have been often found in dead bodies of
peiicms who, during life, had been much affected with
palpitations.

To this head are to be referred all thofe cafes of
palpitation arifing from caufes producing an accumu-
lation of blood in the great veffels near to the heart.
MCCCLIX.

A third head of the cafes of palpitation, is of thofe
arifing from a more violent and rapid influx of the ner-
vous power into the mufcular fibres of the heart. It
is in this manner that I fuppofe various caufes acting
in the brain, and particularly certain emotions of the
rnind, cccafion palpitation.

MCCCLX.

A fourth head of the cafes of palpitation, is of thofe
arifing from caufes producing a weakneis in the acli-
on of the heart, by diminiihing the energy of the
brain with refpect to it That fuch cafes operate in
producing palpitation, 1 prefume from hence, that all
the feveral caufes mentioned above (MCLXXVII. €t feq.)
as in this manner producing fyncope, do often pro-
duce palpitation. It is on this ground that thefe two
difeafcs are affections frequently occurring in the fame
perfon, as the fame caufes may occafion the one or the
other, according to the force of the caufe and mobili-
ty of the perfon afted upon. It feems to be a law of
human ceconomy, that a degree of debility occurring
in any function, often produces a more vigorous exer-
tion of the fame, or at leaft an effort towards it, and
that commonly in a convulfive mar.ner.

I apprehend it to be the convulfive aclion, frequent-
ly ending in ibme degree of a fpafm, that gives ccca-
fion to the intermittent pulfe fo frequently accompa-
nying palpitation.

MCCCLXI.

OF PHYSIC. 184

MCCCLXL

A fifth head of the caufes of palpitation may per-
haps be of thole ariling from a peculiar irritability or
mobility of the heart. This, indeed, may be confi-
dered as a predifponent caufe only, giving occaiion to
the a£tion of the greater part of the • caufes recited a-
bove. But it is proper to obferve, this predifpoiltiori
is often the chief part of the remote caufe ; inibmuch
that many of the caufes producing palpitation would
not have this effect but in perfons peculiarly predif-
pofed. This head, therefore, of the cafes of palpita-
tion, often requires to be diftinguidied from all the
reft.

MGCCLXII.

After thus marking the feveral cafes and caufes of
palpitation, I think it neceilary, with a view to the
cure of this difeafe, to obfervc, that the feveral caufes
of it may be ag:-im reduced to two heads. The firft
is, of thofe confiding in, or depending upon, certain
organic affe&ions of the heart itfelf, or of the great
veiFcls immediately connected with it. The fecond
is, of thofe confiHing in, or depending upon, certain
affections fubfiiting and acting in other parts of the
body, and acting either by the force of the caufe, or
in confequenee of the mobility of the heart.
MCCCLXIIL

With refpect to the cafes depending upon the firil
fet of caufes, I muft repeat here whatjrl find with re-
fpect to the like cafes of fyncope, that I do not know
any means of curing them. They, indeed, admit of
fome palliation, firft > by avoiding every circuniftance
that may hurry the circulation of the blood ; and, fe-
condly, by every means of avoiding a plethoric ftate
of the fyftem, or any occaflonal turgefcence of the
blood. In many of thefe cafes, blood-letting nuy give
a temporary relief: but in fo far as debilkv und mobi-

lity

i8j PRACTICE

lity are concerned, in fiich cafes this remedy is likely
to do harm.

MCCCLXIV.

With refpect to the cafes depending upon the
other fet of caufes, they may be various, and require
very different meafures : J3iit I can here fay in gene-^
nil, that thefe cafes may be coniidered as of two
kinds ; one depending upon primary affections in o^
ther parts of the body, and a6ting by the force of the
particular caufes ; and another depending upon a
ihite of mobility in the heart itfelf. In the fir ft of
thefe, it is obvious, that the cure of the palpitation muft
be obtained by curing the primary affection : which
is not to be treated of here. In the fecond, the cure
mull be obtained, partly by diligently avoiding the oc-
caiional caufes, partly and chiefly by correcting the
mobility of the fyitem, and of the heart in particular ;
for doing which we have treated of the proper means
clfewhere.

CHAP. V.

OF DYSPNOEA, OR DIFFICULT BREATH-
ING.

MCCCLXV.

THE exercife of refpiration, and the organs of it,
have fo conftant and confidcrable a conncclion
with almoft the whole of the other functions and parts
of the human body, that upon almoft every occafion
of difeafe, refpiration muft be affe&ed. Accordingly
fome difficulty and diforder in this function, are in
fact fymptoms very generally accompanying difeafe.

MCCCLXVI.

OF PHYSIC, 185

MCCCLXVI.

Upon this account, the fymptom of difficult breath-
ing deferves a chief place : nd an ample confideration
in the general fyftem of Pathology ; but what mare
of eonfideration it ought to have in a tteatife of Prac-
tice, I find it "difficult to determine.
MCCCLXVIL

On this fubjecl, it is, in the firft place, neceiTary to
diftinguifli between the fymptomatic and idiopathic
affections : that is, between thofe difficulties of breath-
ing which are fymptoms only of a more general af-
fection, or of a difeafe fubfilling primarily in other
parts than the organs of refpiration, and that difficul-
ty of breathing which depends upon a primary affec-
tion of the lungs themfelves. The various cafes of
fymptomatic dyfpncea I have taken pains to enume-
rate in my Methodical Noiblogy, and it will be obvi-
ous they are fuch as cannot be takeri notice of here.
MCCCLXVI1L

In my Nofology I have alfo takeri pains to point
out and enumerate the proper, or at lead the greater
part of the proper, idiopathic cafes of dyfpncea; but
from that enumeration it will, I think, readily ap-
pear, that few, and indeed hardly any, of thefe cafes
will admit or require much of our notice in this place,
MCCCLX1X.

The Dyfpncea Sicca*,fpecies id, the Dyfpncea Ae-
rea\,fp. $d, the Dyfpncea Terrea\^fp. 4^, and Dyf-

VOL. II. A a pncea

* -The definition, which the author gives of this {pecks in Li* No-
fology is Dyfpncea cum tuffi pleriimque iicca It aiiies from vari-
ous canfes, fome of which arc extremely difficult, if not impofiiblc, to
be difcovered.

§ The definition of this fpecies is, Dyfpnoea a minima quuvis
fempeftatum mutatione auda.

^ It is defined Dyfpnoea cum tuffi materiam tcrream vel caleulo-
fam ejiciente. This is fometimcs the expulfion of a gouty matter*.

1 86 PRACTICE

pncea noracica*,Jp. jtb, are fomc of them with diffi-
culty known, and are all of them difeafes which in
my opinion do not admit of cure. All, therefore,
that can be faid concerning them here is, that they
may admit of fome palliation ; and this, I think, is to
be obtained chiefly by avoiding the plethoric (late of
the lungs §, and every circumftance that may hurry
refpiration.

MCCCLXX.

Of the Dyfpncea Extrlnfecaj^ fp. 8/£, I can fay no
more, but that thefe external caufes marked in the
Nofology, and perhaps fome others that might have
like effeds, are to be carefully avoided ; or, when they
have been applied, and their effects have taken place, the
difeafe is to be palliated by the means mentioned in
the laft paragraph.

MCCCLXXI.

The other fpecies, though enumerated as idiopathic,
can hardly be confidered as fuch, or as requiring to
be treated of here.

The Dyfpncea Catarrhalis\^fp. ift, may be conli-
dered as a fpecies of catarrh, and is pretty certainly
to be cured by the fame remedies as that fpecies of ca-
tarrh which depends rather upon the increafed afflux
of mucus to the bronchise, than upon any inflammato-
ry Hate of them||.

The

* The definition of this fpecies is, Dyfpnoea a partibusthoracem
cingentibus'laefis, vcl male conformatis.

§ This intention is moil fpeedily obtained by occafional bleeding.

f It is defined Dyfpnoea a caufis'externis manifeilis. Thefe cauf-
es are various, as expofure to duft of different kinds, to metallic fumes,
to vitiated air, to vapours of different kinds, &c.

J It is defined, Dyfpnoea cum tufli frtquente mucum vifcidein
copiofum ejiciente.

j| The remedies for this purpofe are, emetics, fudorifics, and ex-
pectorants j formulae of which rxiay be fccn in the notes on article
1006,

O F P H T S I C. 187

The Dyfpnoea Aquofa*, fp. $tby is certainly to be
eonfidered as a fpecies of dropfy, and is to be treated
by the fame remedies as the other fpecies of that dif-
eafe.

The Dyfpnoea Pinguedinofa-\, fp. 6th> is in like
manner to be conlidered as a fymptom or local effect
of the Polyfarcia, and is only to be cured by correct-
ing the general fault of the fyftem^:.
MCCCLXXII.

From this view of thofe idiopathic cafes of dyf-
pnoea, which are perhaps all I could properly arrange
under this title, it will readily appear that there is lit-
tle room for treating of them here : but there is flill
one cafe of difficult breathing, which has been proper-
ly diftinguLTied from every other under the title of
Afthma ; and as it deferves our particular attention, I
lhall here feparately confider it.

CHAP, VI.

OF ASTHMA.

MCCCLXXIIL

THE term of Afthma has been commonly applied
by the vulgar, and even by many writers on the
Practice of Phyfic, to every cafe of difficult breathing,

A a 2 that

* It is defined, Dyfpnoea cum urina parca, et ocdemate, pedum,
fine flu6tuatione in pedlore, vcl aliis chara<5terifticis hydrothoracis-
fignis.

•j- It is defined, Dyfpnoea in hominibus valde obefis.

t A low diet, fufficient exercifc, fweating, and brifl^ purges, will
foou have the defired effeft ; and the difeafe may be prevented by
abikmious living.

i88 PRACTICE

that is, to every fpecies of Dyfpnoea, The Methodi-
cal Nofologifts, alfo, have diftinguifhed Afthma from
Dyfpncea chiefly, and almoft folely, by the former be-
ing the fame affection with the latter, but in a higher
degree. Neither of thefe applications of the term
fecms to have been correft or proper, I am of opini-
on, that the term Afthma may be mod properly ap-
plied, and fhould be confined, to a cafe of difficult
breathing that has peculiar fymptoms, and depends
upon a peculiar proximate caufe, which I hope to af-
lign withfufficient certainty. It is thisdifeafc I am now
to treat of, and it is nearly what Practical Writers have
generally diftinguifhed from the other cafes of diffi-
cult breathing, by the title of Spafmodic Afthma, or
of AJtbma convuljivum ; altho* by not diftinguiihing
it with fufficient accuracy from the other cafes of Dyi -
pncea, they have introduced a great deal of confuiiou
into their treatifes on this fubjecl.

DCCCLXX1V.

The difeafe I am to treat of, or the Afthma to be
ftrictly fo called, is often a hereditary difeafe. It*
feldom appears very early in life, and -hardly till the
time of puberty, or after it. It affects both fexes, but
moft frequently the male. I have not obferved it to
be more frequent in one kind of temperament than
in another ; and it does not feem to depend upon any
general temperament of the whole body, but upon a
particular conftitution of the lungs alone. It frequent-
ly attacks perfons of a full habit ; but it hardly ever
continues to be repeated for fome length of time with-
out occasioning an emaciation of the whole body.

MCCCLXXV.

The attacks of this difeafe are generally in the
night-time, or towards the approach of night ; but
there arc alfo fome inftances of their coming on in

the

* This defcription of the difeafe under confideration is excellent.

OF PHYSIC. 189

ithe courfe of the day. At whatever time they come
on, it is for the moft part fuddenly, with a fen(e of
tightnefs and ftriclure acrofs the breaft, and a fenfe of
flraitnefs in the lungs impeding inspiration. The per-
fonthus attacked, if in a horizontal iituation, is imme-
diately obliged to get into fomewhat of an creel: pof-
ture, and requires a free and cool air. The difficulty
of breathing goes on for fome time increafing ; and
both infpiration and exfpiration are performed ilowly?
arid with a wheezing noife. In violent fits, fpeaking
is difficult and uneafy. There is often fome propen-
fity to coughing, but it can hardly be executed.

MCGCLXXVL

Thefe fymptoms often continue for many hours to-
gether, and particularly from midnight till the morn-
ing is far advanced. • Then commonly a remiffion
takes place by degrees ; the breathing becomes lefs la-
borious and more full, fo that the perfon can fpeak and
cough with more eafe ; and, if the cough brings up
fome mucus, the remiffion becomes immediately more
confiderable, and the perfon falls into a much wilhed-
for flee p.

MCGCLXXVII.

During thefe fits the pulfe often continues in its na-
tural (late ; but in fome perfons the fits are attended
with a frequency of pulfe, and with fome heat and
third, as marks of fome degree of fever. If urine be
yoided at the beginning of a fit, it is commonly in
considerable quantity, and with little colour or odour;
but, after the fit is over, the urine voided is in the or-
dinary quantity of a high colour, and fometimcs depo-
fites a fediment. In ibme perfons, during the fit, the
face is a little fluflied and turgid ; but more common-
ly it is fomewhat pa!e and fhrunk.

MCCCLXXVIII.

After fome fleep in the morning, the patient, for
$he reft of the day, continues to have more free and

eafy

190 PRACTICE

eafy breathing, but it is feldom entirely fuch. He
ftill feels fome tightnefs acrofs his breaft, cannot
breathe eafily in a horizontal pofture, and can hardly
bear any motion of his body, without having his
breathing rendered more difficult and uneafy. In the
afternoon he has an unufual flatulency of his fiomach,
and an unufual drowfinefs ; and, very frequently, thefe
fymptoms precede the firft attacks of the difeafe.
Put, whether thefe fymptoms appear or not, the diffi-
culty of breathing returns towards the -evening ; and
then fomelimes gradually increafes, till it becomes as
violent as in the night before : or if, during the day,
the difficulty of breathing has been moderate, and
the perfon got fome ileep in the firft part of the night,
he is, however, waked about midnight, or at fome
time between midnight and two o'clock in the morn-
ing ; and is then fuddenly feized with a fit of difficult
breathing, which runs the fame courfe as the night
before,

MCCCLXXIX.

In this manner fits return for feveral nights fuccef-
fively : but generally, after fame nights palled in this
way, the fits fuifer more confiderable remiffions. This
efpccidlly happens when the remiffions are attended
with a more copious expectoration in the mornings,
and that this tontinues from time to time throughout
the day. In thefe circumflances, afthmatics, for a
long time after, have not only more eafy days, but en-
joy alfo nights of entire fleep, without the recurrence
of the difeafe.

MCCCLXXX.

When this difeafe, however, has once taken place in
the manner above defcribed, it is ready to return at
times for the whole of life after. Thefe returns,
however, happen with different circumftances in dif-
ferent perfons.

MCCCLXXXI.

O F P H Y S I C. 19*

MCCCLXXXI.

In fome perfons the fits are readily excited by exter-
nal heat, whether of the weather or of a warm cham*
her, and particularly by warm bathing. In fuch per-
fons fits are more frequent in fummer, and particular-
ly during the dog-days, than at other colder feafons.
The fame perfons are alfo readily affected by changes
of the weather ; efpecially by fudden changes made
from a colder to a warmer, or, what is commonly the
fame thing, from a heavier to a lighter atmofphere.
The fame perfons are alfo affected by every circum-
ftance threatening the capacity of the thorax, as by
any ligature made, or even by a plafter laid, upon it ^
and a like effect happens from any increafed bulk of
the ftomach, either by a full meal, or by air collected
in it. They are likewife much affected by exercife, or
whatever elfe can hurry the circulation of the blood.
MCCCLXXXII.

As afthmatic fits feem thus to depend upon fome
fulnefs of the veflels of the lungs, it is probable that
an obrlruction of perfpiration, and the blood being
lefs determined to the furface of the body, may fa-
vour an accumulation in the lungs, and thereby be a
means of exciting afthma. This feems to be the cafe
of thofe afthmatics who have fits mod frequently in
the winter-feafon, a|id who have commonly more of a
catarrhal affection 4ccompanying the afthma ; which
therefore occurs more frequently in winter, and more
manifeftly from the application of cold.
MCCCLXXXIIL

Befide thefe cafes of ailhma excited by heat or cold,
there are others, in which the fits are efpecially excit-
ed by powers applied to the nervous fyfiem ; as by
pafTions of the mind, by particular odours, and by ir-
ritations of fmoke and dud.

That this difeafe is an affection of the nervous fyf-
tem, and depending upon a mobility of the moving fi-

292 PRACTICE

bres of the lungs, appears pretty clearly from its be-
ing frequently attended with other fpafmodic affecli-
ons depending upon mobility ; fuch as hyileriaj hy-
pochondriafis, dyfpepfia, and atonic gout.

MCCCLXXXIV. '

From the whole of the hiitory of afthma now deliver-
ed, 1 think it will readily appear, that the proximate
caufe of this difeafe is a preternatural, and in fome
ineafure a fpafmodic, conftridion of the mufcular fibres
of the bronchia ; which not only prevents the dilata-
tion of the bronchiae neceflary to a free and full in-
fpiration, but gives alfo a rigidity which prevents a
full and free expiration. This preternatural conftric-
tion, like many other convulfive and fpafmodic af-
fections, is readily excited by a turgefcenceof the blood,
or other caufe of any unufual fulnefs and diftentioii
of the veflcls of the lungs.

MCCCLXXXV.

This difeafe, as coming by fits, may be generally
diflinguifhed from moft other fpedcjs of dyfpncea, whole
caufes being more conftantly applied, produce there-
fore a more conftant difficulty of breathing. There
may, however, be fome fallacy in this matter, as fome
of thefe caufes may be liable to have abatements and
intenfities, whereby the dyfpnoea produced by them,
may fcem to come by fits ; but I believe it is feldom
that fuch fits put on the appearance of the genuine
afthmatic fits defcribed above. Perhaps, however,
there is ftill another cafe that may give more difficulty ;
and that is, when fcveral of the caufes, which we have
affigned as caufes of feveral of the fpccies of difficult
breathing referred to the genius of Dyfpnoea, may have
t^e effect of exciting a genuine afthmatic fit. Whe-
ther this can happen to any but the peculiarly preciif-
pofed to afthma, I am uncertain ; and therefore, whe-
ther, in any fuch cafes, the afthma may be coniider-
ed as fymptomatic 3 or if, in all iuch cafes, the afthma

may

O F P H Y S I C. 193

rr.ay not ftill be conlidered an3. treated as an icllopa-
thic difeafe.

MCCCLXXXVI.

The afthma, though often threatening immediate
death, feldom occafions it; and many petfons have
lived long under this difeafe. In many cafes, however,
it does prove fatal ; fometimes very quickly, and per-
haps always at length. In fome young perfons it has
ended foon, by occaiioning a phthifis palnionalis. Af-
ter a long continuance, it often ends in a hydrothorax ;
and commonly, by occafioning fome aneurifm of the
heart or great verTels, it thereby proves fatal.
MCCCLXXXVII.

As it is feldom that an afthrna has been entirely cur-
ed; I therefore cannot propofe any method of cure
which experience has approved as generally fuccefsful.
But the difeafe admits of alleviation in feveral refpeds
from the life of remedies ; and my bulinefs now fhall
be chiefly to offer fome remarks upon the choice and
ufe of the remedies which have been commonly em-
ployed in cafes of afthma.

MCCCLXXXVIII.

As the danger of an aft h made fit arifes chiefly from,
the difficult tranfmiffion of the blood through the vcf-
fels of the lungs, threatening fuffocation ; fo the mod
probable means of obviating this feems to be blood-
letting : and therefore, in all violent fits, practitioners
have had recourfe to this remedy. -In firit attacks,
and efpecially in young and plethoric perfons, blood-
letting maybe very necefTary, and is commonly ail-
able. But it is alfo evident, that, under the frequent
recurrence of fits, blood-letting cannot be frequently
repeated without exhaufting and weakening the pati-
ent too much. It is further to be obferved, that blood*
letting is not fo neceffary as might be imagined, as
the pailage of the blood through the lungs is not fo

Voi. II. B b much

PRACTICE

interrupted as has been commonly fuppofed. This I
particularly conclude from hence, that, inftead ok the
fufftifion efface, which is the ufuaLeffe&of fuch inter-
ruption, the face, in afthmatics fits, is often fhrunk
and pale. I conclude the fame alfo from this, that,
in afthmatic fits, blood-letting does not commonly
give fo much relief as, upon trie contrary fuppofition,
might be expected.

MCCCLXXXIX.

As I have alledged above, that a turgefcence of the
blood is frequently the exciting caufe of afthmatic fits,
fo it might be fuppofed, that a plethoric ftate of the
fyftem might have a great fhare in producing a tur-
gefcence of the blood in the lungs ; and efpecially,
therefore, that blood-letting might be a proper reme-
dy in afthma; I allow it to be fo in the fir it attacks
of the difeafe : but as the difeafe, by continuing, gene-
rally takes off the plethoric ftate of the fyftem ; fo, af-
ter the difeafe has continued for fome time, I alledge
that blood-letting becomes lefs and lefs neceffary.
iMCCCXC.

Upon the fuppofition of afthmatics being in a pie-.
thoric ftate, purging might be fuppofed to prove a re-
medy in this diieafe : but, both becaufe the fuppofi-
tion is not commonly well founded, and becaufe purg-
ing is feldom found to relieve the veffels of the thorax,
this remedy has not appeared to be well fuited to afth-
matics ; and large purging has always been found to
do much harm. But as afthmatics are always hurt by
the ftagnation and accumulation of matters in the ali-
mentary canal, fo coftivenefs muit be avoided, and an
open belly proves ufeful. In the time of fits, the em-
ployment of emollient and moderately laxative glyf-
4ers* has been found to give confiderable relief.

MCCCXCI.

* A clyfterof milk, with a little fait, is generally fufficient.
The coitivenefs may be removed by mucilaginous laxatives of the

O F P H Y S I C. 195

MCCCXCI.

As a flatulency of the ftomach, and other fymp-,
toms of indigeftion, are frequently attendants of afth-
ma, and very troublefome to afthmatics; fo, both for
removing thefe iyrnptoms, and for taking off all deter-
mination to the lungs, the frequent ufe of gentle vo-
mits* is proper in this dileafc. In certain cafes, where
a lit was expected to come on in the coujfeof the
night, a vomit given in the evening has frequently
feemed to prevent it.

MCCCXCI!.

Bliftering between the fhouldcrs, or upon the
bread, has been frequently employed to relieve afth-
matics ; but in the pure fpafmodic aflhma we treat of
here, I have rarely found bljfters ufeful, either in pre-
venting or relieving fits.

Mcccxcin.

Ifiues are certainly ufeful in obviating plethora ;
but as fuch indications feldom arife in cafes of afthma,
fo iiTues have been feldom found ufeful in this difeafe.
MCCCXC1V.

As afthmatic fits are fo frequently excited by a tur-
gefcence of the blood, fo the obviating and allaying
of this by acids and neutral fairs, feems to have been
at all times the objec~b of pracliti oners. See FLOYER
on tho Aflhma.

MCCCXCV.

Although a plethoric ftate of the fyflem may feem
to difpofe to aflhma, and the occailonai turgefcence
of the blood may feem to be frequently the exciting
caufe of the fits ; yet it is evident, that the difeafe
mult have arifen chiefly from a peculiar conftitutioTi

B,b 2 in

milder kind, as manna, cafiia, &c. or by a proper attentive to diet,
cfpecially by ufirig the pulps of particular fruits, as prunes or raifms
boiled in barky-water ; roatled applea eaten with brown fugar, &:c.
* Vomits otiolit, in tliefe cafes, to be mild. Some formulae cr -
them are given in one of the notes on article 185:

196 PRACTICE

in the moving fibres of the bronchia?, difpofing them
upon various occalions to fall into a fpafmodic con-
itriction ; and therefore, that the entire cure of the
difeafe can only be expected from the correcting of
that predifpofition, or from correcting the preterna-
tural mobility or irritability of the lungs in that re-
fpect.

MCCCXCVI.

In cafes wherein this predifpolition depends upon
original conformation, the cure mud be difficult, and
perhaps irnpcffible; but it may perhaps be moderated
by theufe of antifpafmodics. Upon this footing, va-
rious remedies of that kind have been commonly em-
ployed, and particularly the fetid gums ; but we have
not found them of any coniiderable efficacy, and have
obferved them to be fometimes hurtful by their heat-
ing too much. Some other antifpafmodics which
might be fuppofed powerful, fuch as mufe, have not
been properly trisd. The vitriolic ether has be£o
found to give relief, but its effects are not lading*

Mcccxcyii.

As in other fpafmodic affections, fo in this, the mcfl
certain and powerful antifpafmodic is opium*. I
have often found it effeelua^ and generally fafe 5 and
if there have arifen doubts with refpect to its fafety,-
I believe they have arifen from not diilinguilhing be-
tween certain plethoric and inflammatory cafes of dyf-
pncea, improperly named Afthfna, and the genuine
Ipafmodic ailhma we treat of here.

MCCCXCVIIL

** The great efficacy cf opium, in cafes of fpafmodic aflhma, is
fally confirmed by experience. It ought to be given in large dofes,'
but not often repeated in the day. , It feems to be moil ufeful when
given occafionally to allay the violence of the fit, or to prevent its
accelfion. Thus, forty drops of laudanum have been frequently
found to relieve the fymptoms when the fit is violent ; or, when tak-
en at the approach cf the fit, to have wholly fupprefied it, or at leall
to have conliderably blunted its violence.

OF PHYSIC. 197

MCGCXCVIII.

As in many cafes this difeafe depends upon a pre-
dlfpolition which cannot becorrecled by our art, fo ill
fuch cafes the patient can only efcape the difeafe by a-
voiding the cccaiional or exciting caufes, which. I have
endeavoured to point out above. It is, however, dif-
ficult to giv^- .-neral rules here, as different afth-
niatics have th-ir different idiofyncraiies with refpecl:
to externals. Thus, one afthmatic finds himfelf eafieft
living in the midft of a great city, while another can-
not breathe but in the free air of the country. In the
latter cafe, however, moil afthmatics bear the air of a
low ground, if tolerable free and drya better than that
of the mountain.

MCCCXC1X.

In diet, alfo, there is forne difference to be made
with refpecl to different afthmatics. None of them
bear a large or full -meal, or any food that is of flow
and difficult folution in the ftomach ; but many of
them bear animal-food of the lighter kinds, and in
moderate quantity. The ufe of vegetables which rea-
dily prove flatulent, are always very hurtful. In re-
cent afthma, and efpecially in the young and pletho-
ric, a fpare, light, and cool diet is proper, and com-
monly neceffary ; bur, after the difeafe has continued
for years, afthmatics commonly bear, and even require,
a tolerably full diet, though in all cafes a very full diet:
is very hurtful.

Mecca

In drinking, water, or cool watery liquors, is the
only fafe and fit drinks for afthmatics ; and ail liquors
ready to ferment and become flatulent, are hurtful to
them. Few afthmatics can bear any kind of ftrong
drir.k ; and any excefs in fuch is always very hurtful
to them. As afthmatics are commonly hurt by taking-
warm or tepid drink; fo, both upon that account, and
upon account of the liquors weakening the nerves of

the

PRACTICE

the ftomach, neither tea nor coffee is proper in this
difeafe.

MCCCCI.

Adhmatics commonly bear no bodily motion eafi-
ly but that of the mod gentle kind. Riding, howe-
ver, on horfeback, or going in a carriage, and cfpeci-
ally failing, are very often ufeful to adhmatics.

C II A P. VII.

OF THE CHINCOUGH, OR HOOPING-
COUGH.

MCCCCII.

THIS difeafe is commonly epidemic, and manifed-
ly contagious. It feems to proceed from a con-
tagion of a fpeciftc nature, and of a fmgular quality.
It does not like mod other contagions, necefianly pro-
duce a fever j nor does it, like mod others, occsiion
any eruption, or produce otherwife any evident change
in the date of the human fluids. It has, in common
with the catarrhal contagion, and with that of the
jneafles, a peculiar determination to the lungs ; but
•with particular effects there, very different from thofe
of the other two ; as will appear from the hidory of
this difeafe now to be delivered.
MCCCCIII.

This contagion, like feveral others, affects perfons
but once in the courfe of their lives ; and therefore,
necelfarily, children are mod commonly the fubjects of
this difeafe : but there are many indances of it occur-
ring in perfons confiderably advanced in life ; though
it is probable, that the further that perfons arc advanc-
ed

OF PHYSIC. 199-

cd in life, they are the lefs liable to be affe&ed with
this contagion.

MCCCCIV.

The difeafe commonly comes on with the ordinary
fymptoms of a catarrh arifing from cold ; and often*
for many days, keeps entirely to that appearance j and
I have, had inftanccs of a difeafe which though evi-
dently arifing from the chincough contagion, never
put on any other form than that of a common ca-
tarrh.

This, however, feldom happens ; for, generally, in
the fecond, and at fartheft in the third, week after
the attack, the difeafe puts on its peculiar and charac-
teriitic fympcom, a convulfive cough. This is a
cough in which the exfpiratory motions peculiar to
coughing are made with more frequency, rapidity,
and violence, than ufual. As thrfe circumftances,
however, in different inftances of coughing, are in
very different degrees ; fo no exac"i limits can be put
to determine when the cough can be ftrictly faid to
be convulliye ; and it is therefore efpecially by ano-
ther circumftance that the chincough is diftinguifhed
from every other form of cough. This circumftance
is, when many exfpiraiory motions have been convul-
fively made, and thereby the air is in great quantity
thrown out from the lungs, a full infpiration is necei-
farily and fuddehly made ; which, by the air rufhing
in through the glottis with unufual velocity, gives a
peculiar found. This found is fomewhat different in
different cafes, but is in general called a Hoop ; ancf
from it the whole of the difeafe is called the Hooping
Cough. When this fonorous infpiration has happen-
ed, the convulfive coughing is again renewed, and con-
tinues in the fame mariner as before, till a quantity of
mucus is thrown up from the lungs, or the contents of
the itomach are thrown, up by vomiting. Either of
r.hcfe evacuations commonly puts an end to the

coughing,

PRACTICE

coughing, and the patient remains free from it for*
fome time after. Sometimes it is only after feveral
alternate fits of coughing and hooping that expectora-
tion or vomiting takes place ; but it is commonly af-
ter the fecond coughing that thefe happen, and put
an end to the fit.

MCCCCV.

When the difeafe,, in this manner, has taken its
proper form, it generally continues for along time af-
ter, and generally from one month to three ; but
fometimes much longer, and that with very various
circumflances.

MCCCCVI.

The fits of coughing return at various intervals,
rarely obferving any exact period. They happen fre-
quently in the courie of the day, and more frequently
riill in the courfe of the night. The patient has com-
monly fome warning of their coming on • and, to a-
void that violent and painful concuilion which the
coughing gives to the whole body, he clings fail to
any thing that is near to him, or demands to be held
fafl by any perfon that he can come at.

When the fit is over, the patient fometimes breathes
faft, and feems fatigued for a little after : but in many
this appears very little ; and children are commonly fo
entirely relieved, that they immediately return to
their play, or what elfe they were occupied in before.
MCCCCVII.

If it happens that the fit of coughing ends in vo-
miting up the contents of the ftomach, the patient is
commonly immediately after feized with a ilrong
craving and demand for food, and takes it in very
greedily.

MCCCCVIII.

At the firft coming on of this difeafe, the expecto-
ration is fometimes none at all, or of a thin mucus
only ; and while this co . to be the cafe, the fits

of

O F P H Y S I C. 201

©f coughing are more violent, and continue longer;
but commonly rhe expectoration foori becomes con-
liderabie, and a very thick mucus, often in great
quantity, is thrown up ; and as this is more readily
brought up, the fits of coughing are of fhorter dura-
tion.

MCCCCIX.

The violent fits of coughing frequently interrupt
the free tranfmiffion of the blood through the lungs,
and thereby the free return of blood from the veffeis
of the head. This occafions that turgefcence and fuf-
fufion of face which commonly . attends the fits of
coughing, and feems to occafioil alfo thofe eruptions
of blood from the nofe, and even from the eyes and
ears, which fometimes happen in this difcafe.
MCCCCX. ;

This difeafe often takes place in the manner we
have now defcribed, without any pyrexia attending
it; but, though Sydenham had feldom obferved it,
we have found the difeafe very frequently accompani-
ed with pyrexia, fometimes from the very beginning,
but more frequently only after the difeafe had conti-
nued for fome time. When it docs accompany the
difeafe, we have not found it appearing under any re-
gular intermittent form. It is conitantly in fome de-
gree prefent ; but with evident exacerbations towards
evening, continuing till next morning.
MCCCCXI.

A nether fymptom v ery frequently attending the chin-
1 cough, is a difficulty of breathing ; and that not only
limmediately before and after fits of coughing, but as
Iconflantly prefent, though in different degrees in dif-
ferent perfons. I have hardly ever feen an inflance of
a fatal chincough, in which a confiderable degree of
pyrexia and dyipnoea had not been for fome time con-
Itantly pretent.

VOL. II. C c MCCCCXIL

201 P R A

MCCCCXIF.

When by the power of the contagion this difeafe
has once taken place, the fits of coughing are often re-
peated, without any evident exciting caufe : but, in
many cafes, the contagion may be confidered as giv-
ing a predifpoiition only ; and the frequency of fits
depends in feme meafure upon various exciting cau-
fes ; fuch as, violent exercife ; a full rneal ; the having
taken in food of difficult foiution ; irritations of the
lungs by dud, fnioke, or difagreeable odours of a ilrong
kind ; and, efpecially any confiderable emotion of the
mind.

MCCCCXIIL

Such are the chief circumftances of this difeafe,
and it is of various event ; which, however, may be
commonly forefeen by attending to the following
confederations.

The younger that children are, they are in the
greater danger from this difeafe; and of thofe to whom
it proves fatal, there are many more under two years
old than above it.

The older that children are, they are the more fe-
cure againil an unhappy event ; and this I hold to be
a very ^general rule, though I own there are many ex-
ceptions to it.

Children born of phthifical and afthmatic parents
are in the greateft danger from this difeafe.

When the difeafe, beginning in the form of a ca-
tarrh, is attended with fever and difficult breathing,
and with little expectoration, it often proves fatal,
without taking on the form of the hooping cough ;
but, in rnoft of fuch cafes, the coming on of the con-
vulfive cough and hooping, bringing on at the fame
time a more frequent expectoration, generally removes
the danger.

When the difeafe is fully formed, if the fits are nei-
ther ficqueut nor violent, with moderate expectora-
tion,

OF PHYSIC. 203

tion, and the patient, during the intervals of the fits,
is eafy, keeps his appetite, gets deep, and is without
fever or difficult breathing, the difeafe is attended with
no danger ; and thefe circumftances becoming daily
more favourable, the difeafe very foon fpontaneoufly
terminates.

An expectoration, either very fcunty or very copi-
ous, is attended with danger 5 efpecially if the latter
circumftance is attended with great difficulty of breath-
ing.

Thofe cafes in which the fits terminate by a vomit-
Ing, are immediately followed by a craving of food,
are generally without danger.

A moderate hemorrhagy from the nofe often proves
falutary ; but very large heinorrhagics are generally
very hurtful.

This difeafe corning upon perfons under a flate of
much debility, has very generally an unhappy event.

The " danger. of this difeafe fometimes arifes from,
the violence of the fits of coughing, oecafioning apo-
plexy, epilepfy, or immediate fuffocation : but thefe
accidents are very rare ; and the danger of the difeafe
feems generally to be in proportion to the fever and
dyfpncea attending it.

MCCCGXIV.

The cure of this difeafe has been always confidered
as difficult, whether the purpofe be to obviate its fatal
tendency when it is violent, or merely to ihorren the
courfe of it when it is mild. When the contagion is
recent, and continues to act, we neither know how
to correct, nor how to expel it ; and therefore the dif-
eafe neceilarily continues forfome time: but it is pro-
Jbab!e5 that the contagion in this us in other initance^
Ceafes at length to act ; and that then the difeafe con-
tinues, as in other convulfive affections, by the power
of habit alone. C c 2

MCCCCXV.

204 PRACTICE

v.

MCCCCXV.

From this view of the matter I maintain, that
pra&ife mud be different, and adapted to two differ-
ent indications, according to the period of the difeafe.
At the beginning of the difeafe, and for fome time af-
ter, the remedies to be employed muft be fuch as may
obviate the violent effeds of the difeafc, and the fatal
tendency of it; but, after the difeafe has continued
for fome time, and is without any violent fymptoms,
tVie only remedies which can be required are thofe
which may interrupt its courfe, and put an entire flop
to itfooner than it would have fpontaneoufly ccafed.

Mccccivi.

For anfwering the firit indication. In plethoric fub-
jects, or in others, when from the circumftances of
the cough and firs it appears that the blood is diffi-
cultly tr an i'mittx-d through the lungs, blood-letting*
is a neceflafy i^m'-Jy ; and it may be even neceflhry.
to repeat it, efptciaily in the beginning of the diieaie :
but, as fpafrnodic affections do not commonly admit
of much bleeding, ib it is feldom proper in the chin-
eou^h to repeat thjs remedy often. \
M CCCCXV1L

As cofcivenefs frequently attends this difeafe, fo it-
is neceffary to obviate or remove it by laxatives em-
ployed; and keeping an open belly is generally ufe-
ful : but large evacuations in this way are commonly,
hurtfulf.

MCCCCXVIII.

To obviate or remove the inflammatory determiiir

ation'

* Bleeding, in thefc cafes, isbeft performed by leeches ; and they
feem to give greater relief when applied about the neck than on any
other part.

•j- In general, the belly may be kept open by a proper attention
to diet : roaited apples, eaten with brown fugar, flewed prunes, an4?
other firrri'ar food, which, children generally devour with avidity, fuf-^
ficiently anfwcr the purpofe of removing or preventing coHivcncfs.,

QF PUTS I C.

ation to the lungs that fornetimes occur5 in this dif-
enfej bliftering is often ufefui., and even repeated blif-
tering has been of fervice ; but iffucs havs not fo
much effect, and fhould by no means fuperfede the re-
peated bliftering that may be indicated. When biif-
ters are proper, they are more eifeelual when applied
to the thorax, than when applied to any diftant parts.

MCCCCXIX

Of all other remedies, emetics are the molt ufcul in
this difeafe ; both in general by interrupting the re-
turn of fpnf modi c afFe&ions, and in particular by de-
termining very powerfully to the furfacc of the body,
and thereby taking off determinations to the lungs.
For thcfe purpofes, I think, full vomiting is frequently
to be employed ; and, in the intervals neceifary to b-2
left between the times of full vomiting, naufeating do-
fcs of the antimoniai emetics may be ufefui*. I have
never found thtjulphur auralum, fo much praifed by
Clofiius, to be a convenient medicine, on account of
the uncertainty of its dofe ; and the tartar emetic, cm-
ployed in the manner directed by the late Dr. Fotijer-
gill, has appeared to be more ufefui.

MCCCCXX.

* The method of giving tartar emetic in naiffcattng dofes has
ncen frequently mentioned in preceding notes ; but in cafes of chin-
rou^h, where children are generally our patients, we arc under the
j;ec^iTity of varving the do fcs to the age and conftitutj.m. When
the child is under a year old, we ought to ufc the weak folution of
tartar emetic, fpecified in the end of the lafl note on article 185, in
repeated dofes of a table- fpoonful every ten or fifteen minutes, till
it operates. Large dofes, efpecially to young children, are frequent-
ly attended with dangerous confequences, of which the following
cafe is a fuSicftnt proof.

'I'o ? dhild not ten months old, that laboured under thechiocougli,
half a gr::in of tartar emetic was giveu in a little cinnamon-water.
A violent vomiting was produced, and the child died fuddcnly, dur
ir.g the aflion of the medicine : on infpecliing the body after death,
we found the ftomaeh burft, there being in it a laceration that ad-
mitted two fingers. The infpe&ion of th.'s body has 'always made
me extremely cautious in admiriiftering emetics to young children.

266 PRACTICE

MCCCCXX.

Thefe are the remedies to be employed in the firft
ftage of the difeafe for obviating its fatal tendency,
and putting it into a fafe train. But in the fecond
ftage, when I fnppofe the contagion has ceafed to act,
and that the difeafe continues merely by the power of
habit, a different indication arifes, and different re-
medies are to be employed.

MCCCCXXI.

This difeafe, which often continues for a long time.,
does not, in my opinion, continue during the whole
of that time in ccnfequence of the contagion's re-
maining in the body, and continuing to ad in it.
That the difeafe does often continue long after the
contagion has ceafed to a6t, and that too by the pow-
er of habit alone, appears tome probable from hence,
that terror has frequently cured the difeafe ; that any
confiderable change in the ftate of the fyitem, fuch as
the coming on of the frnall-pox, has alfo cured it 5 and
laftly, that it has been cured by antifpafmodic and to-
nic medicines ; whilft none of all thcfe means of cure
can be fuppofed either to ported or to expel a mor-
bific matter, though they are evidently fuited to
change the ftate and habits of the nervous fyftem.
MCCCCXXII.

From this view we are directed to the indication
that may be formed, and in a great meafure to the re-
medics which may be employed in what we fuppofe to
be the fecond ftage of the difeafe. It may perhaps be
alledged, that this indication of fhortcning the courfe
of the difeafe is not very important or necefTary, as ic
fuppofes that the danger or violence is over, and, in
confequence, that the difeafe will foon fpontaneoufly
ceafe. The laft fuppofition, however, is not well
founded ; as the difeafe, like many other qonvulfive
and fpafmodic affeclions, may continue for a long
time by the power of habit alone, and by ths repeti-
tion

O F P H Y S I C. 207

tion of paroxyfms may have hurtful effects; more efpe-
cially as the violence of paroxyfms, and therefore
their hurtful effects, may be much aggravated by va-
rious external caufes that may be accidentally applied.
Our indication, therefore, is proper; and \ve proceed
to conlider thcfeveral remedies wftich may be employ-*
ed to anfwer it.

MCCCCXXIII.

Terror may pofubly be a powerful remedy, but it is
difficult to meafure the degree of it that Ihall bs pro-
duced ; and, as a flight degree of it may be ineffectual*
and a high degree of it dangerous, I cannot propofs
to employ it.

MCCCCXXIV.

The other remedies which we fuppofe fuited to our
fecond indication, and which indeed have been fre-
quently employed in this difeafe, are antifpafmodics
or tonics.

Of the antifpafmodics, caflo-r has been particularly
recommended by Dr. Morris ; but in many trials we
have not found it effectual.

With more probability rnufk has been employed :
but whether it be from our not having it of a genuine
kind, or not employing it in fufficiently large dofes, I
cannot determine ; but we have not found it common-
ly fuccefsful. Of antifpafrnodics, the moft certainly
powerful is opium : and when there is no confident
ble fever or difficulty of breathing prefent, opium has
often proved ufcful in moderating the violence of the
chincough ; but I have not known it employed fo as
entirely to cure the difeafe.

If hemlock \v«$ proved a remedy in this difeafe, as
we muft believe from Dr. Butter's accounts, I agree
with that author, that it is to be coniidered as an an-
tifpafrnodic. Upon this fuppofition, it is a probable
remedy ; and from the accounts of Dr. Butler and
fome others, it feems to have been often ufeful : but,

in

2oS P R A C T I C £

in our trials, it has often difappointed us, perhaps
from the preparation of it not having been always
proper*.

MCCCCXXV.

Of the tonics, I qgnfider the cupmofs, formerly ce-
lebrated, as of this kind ; as alfo the bark of the mif-
Ictoe ; but I have had no experience of either, as I
have always trufled to the Peruvian bark. I conlider
the ufe of this medicine as the moft certain means of
curing the diieafe in its fecond flage ; and when there
has been little fever prefent, and a fufficient quantity
of the bark has been given, it has feldorn failed of
foon putting an end to the difeafe.
MCCCCXXVI.

When convulfive diforders may be fuppofed to con-
tinue by the force of habit alone, it has been found
that a considerable change in the whole of the cir-
cumftances and manner of life has proved a cure of
fuch difeafes ; and analogy has applied this in the
cafe of the chincough fo far, that a change of air has
been employed, and fuppofed to be ufeful. In feve-
ral inftances I have obferved it to be fo ; but I have
never found the effects of it durable, or fufficient to
put an entire ilop to the difeafe.

BOOK

* Experience has not found that any of the antifpafmodics have
ever been employed with much advantage in this difeafe. Ail of
them are extremely naufeous, and corifequently difficultly given to
children who cannot well f wallow pills.

OF PHYSIC; 209

BOOK IIL SECT. III.

OF THE SPASMODIC AFFECTIONS IN THE
NATURAL FUNCTIONS.

CHAP. VIIL

OF THE PYROSIS, OR WHAT IS NAMED IN
SCOTLAND THE WATER-BRASH.

MCCCCXXVII.

THE painful fenfations referred to the ftomach, and
which are probably occaiioned by real affedions
of this organ, are of different kinds. Probably they
proceed from affections of different natures, and ihould
therefore be diflinguifhed by different appellations ;
'but I muft own that the utmoft precifion in this mat-
ter will be difficult. In my effay towards a methodi-
cal Nofology, I have, however, attempted it. For
thofe pains that are either acute and pungent, or ac-
companied with a fenfe of diflenfion, or with a fenfe of
conftridlion, if they are at the fame time not attended
with any fenfe of acrimony or heat, I employ the ap-
pellation of Gaftrodynia. To exprefs thofe painful or
uneafy fenfations which feem to arife from a fenfe of
acrimony irritating the part, or from fuch a fenfe of
heat as the application of acrids, whether externally
or internally applied, often gives, I employ the term
of Cardialgia ; and by this I particularly mean to de-
note thofe feelings which are exprelfed by the term
Heartburn in the Englifh language. I think the term
Soda has been commonly employed by practical wri-
ters, to exprefs an affedion attended with feelings of
the latter kind,

VOL. II. D d MCCCCXXVIII.

PRACTICE

MCCCCmFVIII.

Bciidc the pains denoted by the terms Gaftrodinia,
Pcriadynia, Cardialgia, and Soda, there is, I think,
another painful ienfation different from all of thefe,
which is named by Mr. Sauvages Pyrofis Suecica ;
and his account of it is taken from Linnaeus, who
names it Cardialgia Sputatoria. Under the title of
Py rolls Mr. Sauvages has formed a genus, of which
the whole of the fpccies, except the eighth, which he
gives under the title of Pyrofis Suecica, .are all of
them fpecies of the Gaftrodynia or of the Cardialgia ;
and if there is a genus to be formed under the title of
Pyrofis, it can in my opinion comprehend only the fpe-
cies I have mentioned. In this cafe, indeed, I own
that the term is not very proper ; but my averfion to
introduce new names has made me continue to employ
the term of Mr. Sauvages.

MCCCCXXIX.

The Gaftrodynia and Cardialgia I judge to be for
the mod part fymptomatic affections ; and therefore
have given them no place in this work : but the Py-
rofis, as an. idiopathic difeafc, and never before treat-
ed of in any fyftcm, I propofe to treat of here.
MCCCCXXX.

It is a difeafe frequent among people in lower life,
but occurs alfo, though more rarely, in people of
better condition. Though frequent in Scotland, it is
by no means fo frequent as Linnaeus reports it to be
in Lapland. It appears moil commonly in perfons
under middle age, but fcldom in any perfons before
the age of puberty. When it has once taken place,
it is ready to recur occafionally for a long time after;
but it feldom appears in perfons confiderably advanc-
ed in life. It affects both fexes, but more fre-
quently the female. It fometimes attacks pregnant
women, and fome women only when, they are in that
condition. Of other women, it more frequently af-
fects

OF PHYSIC. an

feds the unmarried ; and of the married, mod fre-
quently the barren. I have had many inftances of
its occurring in women labouring under afluor albus.

MCCCCXXXI.

The fits of thisdifeafe ufuallycome on in the morn-
ing and forenoon, when the flomach is empty. The
firit fymptcm of it is a pain at the pit of the fiomach,
with a fenfe of confthclion, as if tne itomach was
drawn towards the back ; the pain is increafed by
raifing the body inco an creel pofture, and therefore
the body is bended forward. This pain is often very
fevere ; and, after continuing for feme time, it brings
on an eructation of a thin watery fluid in coniiderable
quantity. This fluid has fometimes an aciid tafte,
but is- very often abfoiutely iniipid. The' emulation
is for fome time frequently repeated ; and do,es not
immediately give relief to the pain which preceded
it, but does fo at length, and puts an end to the fit.
MCCCCXXXIL

The fits of this difeafe commonly corne on without
any evident exciting caufe ; and I have not found it
fleadily connected with any particular diet. It at-,
tacks peribns ufing animal food, but 1 think more fre-
quently thofe living on milk and farinacea. It feems
often to be excited by cold applied to the lower ex-
tremeties : and is readily excited by any confiderabie
emotion of mind. It is often without any fymptoms,
of dyfpepfia.

MCCCCXXXUL

The nature of this afFedion is not very obvious:
but I think it. may be explained in this manner : It
feems to begin by a fpafrn of the mulcular fibres of
die ftomach ; which is afterwards, in a certain man-
ner, communicated to the blood-veflels and exhahnts,
fo as to increafe the impetus of the fluids in thefe vef-
fels, while a conftridion takes place on their extremi-
ties. While therefore the increafed impetus deter-
D d 2 mines

P R A C T ICE

mines a greater quantity than ufual of fluids into thofe
veflels, the conftri&ion upon their extremeties allows
only the pure watery parts to be poured out, analogous,
as I judge, in every refpeft, to what happens in the
diabetes hyftericus.

MCCCCXXXIV.

The practice in this difeafe is as difficult as the the-
ory. The paroxyfm is only to be certainly relieved
by opium. Other antifpafmodics, as vitriolic ether
and volatile alkali, are fometimes of fervice, but not
conftandy fo. Although opium and other antifpaf-
modics relieve the fits, they have no effect in prevent-
ing their recurrence. For this purpofe, the whole of
the remedies of dyfpepfia have been employed without
fuccefs. Of the ufe of the nux vomica, mentioned ?.?.
a remedy by Linnaeus, I have had no experience.

CHAP. IX.

OF THE COLIC.

MCCCCXXXV.

THE principal fymptom in this difeafe is a pain
felt in the lower belly. It is felclom fixed and1
pungent in one part, but is a painful diftenfion in
fome meafu're fpreading over the whole of the belly ;
and particularly with a fenfc of twilling or wringing
round the navel. At the fame time, with this pain,
the navel and teguments of the belly are frequently
drawn inwards, and often the mufcles of the belly are
fpafmodically contracted, and this in feparate portions,
Divine the appearance of a bag full of round balls.

MCCCCXXXVI.

OF PHYSIC sig

MCCCCXXXVI.

Such pains, in a certain degree, fometiines occur in
cafes of diarrhoea and cholera ; but thefe are lefs vio-
lent and more traniitory, and are named Gripings.
It is only when more violent and permanent, and at-
tended with coftivenefs, that they conftitute colic.
This is alfo commonly attended with vomiting., which
in many cafes is frequently repeated, efpecially when
any thing is taken down into the flomach ; and in
fuch vomitings, not only the contents of the flomach
are thrown up, but alfo the contents of the duodenum,
and therefore frequently a quantity of bile.
MCCCCXXXVIL

In fome cafes of colic, the perifcaltic motion is in-
verted through the whole length of the alimentary
canal, in fuch a manner that the contents of the great
guts, and therefore ftercoracecus matter, is thrown up
t>y vomiting ;%and the lame inverfion appears flill
more clearly from this, that what is thrown into the
rectum by glyfter is again thrown out by the mouth-
In thefe circumftances of inverfion the -ctiieafe has been
named Ileus, or the Iliac Pailion ; and this has been
fuppofed to be a peculiar difeafe diftincl: from colic ;
but to me it appears that the two difcafes are owing to (
the fame proximate caufe, and have the fame Symp-
toms, only in a different degree.

MGCCCXXXVIII.

The colic is often without any pyrexia attending it:
Sometimes, however, an inflammation comes upon
the part of the interline efpecially affected ; and this
inflammation aggravates all the fymptoms of the dif-
eafe, being probably what brings on the moft confi-
derable inverfion of the • pcriftaltic motion; and, as
the ftercoraceous vomiting is what efpecially diiiin-
guimcs the ileus, this has been confidered as always
depending on an inflammation of the interlines. How-
ever, I can affirm, that as there are inflammations of

the

PRACTICE

the inteftines without flercoraceous vomiting, fo I have
feea inftances of flercoraceous vomiting without in-
flammation ; and there is therefore no ground for dif-
tinguiihing ileus from colic, but as a higher degree of
the fame aftedlion.

MCCCCXXXIX.

The fymptoms of the colic, and the diflc&ions of
bodies dead of this difeafe, fhow very clearly, that it
depends upon a fpafmodic conftricYion of a part of the
intcftines ; and that this therefore is to be confidered
as the proximate caufe of the difeafe. Infome of the
difledions of perfons dead of this difeafe, an intus-luf-
ception has been remarked to have happened; but
whether this be conftantiy the cafe in all the appear-
ances of ileus, is not certainly determined.
MCCCCXL.

The colic has commonly been confidered as being
of different fpecies, but I cannot follow the writers on
this fubjeci in the diftindions they have cftablifhed.
So far, however, as a difference of the remote caufe
confbitutes a difference of fpecies, a diflindion may per-
haps be adaiiited; and acco»ding]y in my Nofology I
have marked feven different fpecies : but I am well
perfuaded, that in all thefe different fpecies the prox-
imate caufe is the fame, that is, a fpafmodic conftridion
of a part of the inteftines; and confequently, that in
all thefe cafes the indication of cure is the fame, that
is, to remove the conftrifltion mentioned. Even in
the feveral fpecies named Stercorea^ Callofa^ and Cal-
culofd) in which the difeafe depends upon an obilruc-
tipn of intefline, I am perfuaded that thefe pbftrttdtr-
ons do not produce the fymptoms of colic, excepting
in fo far as they produce fpafmodic conftriclions of the
inteftines ; and therefore, that the means of cure in
thefe cafes, fo far as they admit cf cure, muft be ob-
tained by the fame means which the general indica-
tion above mentioned fudged s.

MCCCCXLI.

O F P H Y S I C. 215

MCCCGXLI.

The cure, then, of the colic univerfally, is to be ob-
tained by removing the fpafmodic conftridions of the
inteftmes ; and the remedies fuited to this purpofc
may be referred to three general heads :

1. The taking off the fpafm by various amifpafmo-
dic powers.

2. The exciting the action of the inteilines by pur-
gatives.

3. The employing mechanical dilatation.

MCCCCXLII.

Before entering upon a more particular account of
thefe remedies, it will be proper to obferve, that in all
cafes of violent colic, it is advifabie to pradlife blood-
letting ; but as it may be ufeful in obviating the in-
flammation which is commonly to be apprehended,
and even as it may be a means of relaxing the fpafra
of the inteftine. This remedy may perhaps be im-
proper in perfons of a weak and lax habit, but in all
perfons of tolerable vigour it will be a fafe remedy ;
and in all cafes where there is the leafl fufpicion of
an inflammation actually coming on, it will be abfo-
lutely neceflary. Nay, it will be even proper to re-
peat it perhaps fever al rimes, if, with a full and hard
pulfe, the appearance of the blood drawn, and the re-
lief obtained by the firft bleeding, fhall authorife fuch
repetition.

MCCCCXLIII.

The antifpafmodic powers that may be employed,
are, the application of heat in a dry or humid form,
the application of blifters, the ufe of opium, and the
ufe of mild oils.

The application of heat, in a dry form, has been
employed by applying to the belly of the patient a
living animal, or bladders filled with warm water, or
bags of fubilances which long retain their heat; and
all thefe have fometimes been applied with fuccefs ;

but

PRACTICE

but none of them feem to me fo powerful as the appli-
cation of heat in a humid form.

This may be employed either by the immerfion of
a great part of the body in warm, water, or by fo-
menting the belly with cloths wrung out of hot water.
The immerfion has advantages from the application of
it to a greater part of the body, and particularly to
the lower extremities: but immerfion cannot always
be conveniently practifed, and fomentation may have
the advantage of being longer continued ; and it may
have nearly all the benefit of immerfion, if it be at
the fame time applied both to the belly and to the
lower extremities.

MCCCCXLIV.

From confidering that the teguments of the lower
belly have fuch a connection with the interlines, as at
the fame time to be affected with fpafmodic contrac-
tions, we perceive that bliflers applied to the belly
may have the effect of taking off the fpafms both from
the mufcles of th£ belly and from the interlines ; and
accordingly, bliftering has often been employed in the
colic with advantage. Analogous to this, rubefaci-
ents applied to the belly have been frequently found
ufeful.

MCCCCXLV.

The ufe of opium in colic may feem to be an ambi-
guous remedy. Very certainly it may for fome time
relieve the pain, which is often fo violent and urgent,
that it is difficult to abflain from the ufe of fuch a re-
medy. At the fame time, the ufe of opium retards
or fufpcnds the periftaltic motion fo much, as to allow
the interlines to fall into conflrictions ; and may there-
fore, while it relieves the pain, render the caufe of
the difeafe more obflinate. Oa this account, and
further as opium prevents the operation of purga-
tives fo often neceifary in this difeafe, many practiti-
oners are averfe to the ufe of it, and fome entirely re-

O F P H Y S I C. 217

jedt the ufe of it as hurtful. There are, however, o-
thers who think they can employ opium in this difcafe
with much advantage.

In all cafes where the colio comes on without any
previous cofliveneis, and ai ifes from coldj from pafli-
ons of the mind, or other caufes which operate efpeui-
ally on the nervous fyftem, opium proves a fafc and
certain remedy > but in cafes which have been preced-
ed by long coitivenefs, or where the colic, though not
preceded by coflivenefs, has however continued for
fome days without a ilool, fo that a flag-nation offices
in the colon is to be fufpeded, the ufe of opium is of
doubtful effect. In ftich cafes, unlefs a itool has been
firit procured by medicine, opium cannot be employ-
ed but with fome hazard ot aggravating the difeafe.
However, even in thofe circumitances of cofliveneis,
when, without inflammation, the violence of the fpafra
is to be fufpecled, when vomiting prevents the exhibi-
tion of purgatives, and when with all this the pain is
extremely urgent, opium is to be employed, not only
as an anodyne, but alfo as an antifpaimodic, neceiTary
to favour the operation of purgatives ; and may befo
employed, when, either at the fame time with the opi-
ate, or not long after it, a purgative can be exhibited.

Is the hyoiciamus, as often ihowing, along with its
narcotic, a purgative quality, better iuited to this dif-
eafe than opium ?

MCCCCXLVI.

It is feemingly on good grounds that feveral prac-
titioners have recommended the large ufe of mild oils
in this difeafe, both as antifpafmodics and as laxatives ;
and, where the palate and (tornach could admit them,
I have found them very ufeful. But as there are few
Scottiih itomachs that can admit a large ufe of oils, I
have had few opportunities of employing them.
MCCCCXLVII.

The fecond fet of remedies adapted to the cure of

VOL. II. E e colic,

2i8 P R A C T I C E

colic, are purgatives ; which, by exciting the adion
of the intcftines, either above or below the cbftruftcd
place, may remove the conftridion ; and therefore
thefe purgatives may be given either by the mouth,
or thrown by glyiter into the anus. As the difeale is
often feated in the great guts ; as glyfters, by having a
more fudden operation, may give more immediate re-
lief; and as purgatives given by the mouth are ready
to be rejected by vomiting ; fo it is common, and in-
deed proper, to attempt curing the colic in the firft
place by glyfters. Thefe may at firft be of the mildeft
kind, confiding of a large bulk of water, with fome
quantity of a mild oil; and fuch are fometimes fuffi-
cientiy efficacious : however, they are not always fo ;
and it is commonly neceflary to render them more
powerfully ftimulant by the addition of neutral falts,
of which the moft powerful is the common or marine
fait. If thefe faline glyfters, as fometimes happens, are
rendered again too quickly, and on thisaccountor other-
wife are found ineffectual, it may be proper, inftead
of thefe falts, to add to the glyfters an infufion of fen-
na, or of fome other purgative that can be extracted
by water. The antimonial wine* may be fometimes
employed in glyfters with advantage. Hardly any
glyfters are more effectual than thofe made of turpen-
tine properly § prepared. When all other injections

are

* Tartar Emetic is furer than the antimonial wine ; bat it is a
very violent remedy, and ought to be ufed with caution even in cly-
fters. Five or fix grains is the ufual quantity given in clyfters.
§ The proper manner of preparing turpentine clyfters is as follows :
R. Terebx Venet. 3vi.
V»tel. Ov. No. ii.

Ttre in mortario marmorco donee pcnitus folvetur
Terebhuhina ; dein addc gradatiin,
Aq. font, frigida, ^ii.
Huic afFunde

O F P H Y S I C. 219

are found ineffectual, recourfe is to be had to the in-
jection of tobacco-fmoke ; and, when even this fails,
recourfe is to be had to the mechanical dilatation to
be mentioned hereafter.

MGGCCXLVIIL

As glyflers often fail altogether in relieving this
difeafe, and as even when they give feme relief they
are often imperfedtin producing acompletecure; foitis
generally proper, and often necelTary, to attempt a more
entireand certaincure bypurgatives given by the mouth.
The more powerful of thefe, or, as they are called* the
Draftic Purgatives, may be fometimes neceffkiy ; but
their ufe is to be avoided, both becaufc they are apt to
be rejected by vomiting, and becaufe when they do
not fucceed in removing the obftruclion they are rea-
dy to induce an inflammation, Upon this account it
is ufual, and indeed, proper, at lead in the nrrt place,
to employ the milder and lefs inflammatory purgatives.
None have fucceeded with me better than the cryf-
tals of tartar*, becaufe this medicine may be conve-
niently given, in fmall but repeated dofes, to aconfi-
derable quantity; and under this management it is
the purgative lead ready to be rejected by vomiting,
and much lefs fo than the other neutral falts. If a
flronger purgative be required, jalap §, properly pre-

E e 2 pared,

Aq. font, tepid, ibi.
M. f. Enema, ttatim injiciend.

If the turpentine does not diflolve fufficiently with the yolks of
two eggs, a third may be added.

* Crytlals of tartar may be given in dofes of two drams each, re-
peated every two hours oroftener. The chief objection againfi: the
ufe of this fait is its difficult foiution in water, and therefore many
practitioners prefer the folubie tartar, or the Rochelfalt.

§ The Pulvis Jalap, comp. of the Edinburgh Pharmacopoeia an-
fwer* in general very well ; but, the following formula is lefs liabTe
to be rejected by the vomiting which fo frequently accompanies this
difeafe.

]$.. Refin. Jalap gr. xii.

Amygdal. dulc. decorticat. No. TI.

220 PRACTICE

pared, is lefs offensive to the palate, and fits better
upon the ftomach, than mofl other powerful purga-
tives. On many occafions of colic, nothing is more
effectually purgative than a large d^fe of calomel*.
Some practitioners have attempted to remove the ob-
frructions of the inteftines by antimonial emetics§ ex-
hibited in fmall dofes repeated at proper intervals ;
and when thefe dofes are not entirely rejected by vo-
miting, they often prove effectual purgatives.

When every purgative has failed, the action of the
inteftines has been effectually excited by throwing
cold water on the lower extremities.
MCCCCXLIX.

The third means of overcoming the fpafm of the in-
teftines in this difeafe, is by employing a mechanical
dilatation ; and it has been frequently fuppofed that
quickfilver, given in large quantity, might operate in
tliis manner. I have not, however, found it fucccfs-
ful ; and the theory of it jjs with me very doubtful.
Some authors Jtave mentioned the ufeof gold and fil-
ver pills, or balls, fwallowed down ; but I have no ex-
perience of fuch practices, and I cannot fuppofe them
2 probable means of relief.

MCCCCL.

Another means of mechanical dilatation, and a

moi

Sacch. alb. gi.

Tere in mortario marmoreo, et adde gradatim,

Aq. Cinnamom. fitnpl. ^i*

M. f hauft.

Half of this portion may be given at once, and tbc other half an hour
afterward.

* This is French pra&ice, but it is dangerous. It has however
been ferviceablc in many cafes, when given in dofes of 12 or 15
grains, or even a fcruple when other purgatives have failed.

$ As the ftomach (as was before obferved) is very imtable in this
difeafe, the pra&itioner will find confiderable difficulty in managing
antimonials. It is better to avoid them altogether, fpr they may
do much mifchJef.

OF PHYSIC. 221

more probable meafure, is by injecting a larje quan-
tity of warm water by a proper fyringe, which may
throw it with fome force, and in a continued ft ream,
into the rectum. Both from the experiments report-
ed by the late Mr. De Haen, and from thcfc I myfeif
have had occafionto make, 1 judge this remedy to be
one of the moil powerful and effectual*.
MCCCCLI.

I have now mentioned ail the fevcrrJ mean; that
may be employed for the cure of the colic, confidered
as a genus ; but before I quit this fubjecl, it may be
exped^d that I fhould take notice of fome of the fpe-
cies which may fcem to require a particular confldera-
tion. In this view it may be expt&ed that I fhould
efpecuilly take notice of the fpeci^s named the Colic
of Poitou, and particularly knov/n in England by the
name of the Devonshire Colic.

MCCCJLJI.

This fpecies of the difeafe is certainly a peculiar
one, both in refpect of its caufe and its efft&s ; but,
as to the firft, it has been lately fo much the fubjecl:
of invefligation, and is fo well afcertained by the
learned phyficians. Sir George Baker and Dr. Hardy,
that it is unneeellary for me to fay any thing of it
here.

With refpecl to the cure of it*, fo far as it appears

It is to be thrown up, by means of a lame fyn'nje, in fu?^
quantises, till the patient begins to feel a ftnfe of uneafincf f«- n
the great diftention which it occasions. Some patients haw !
two gallons to be ir.jccted, and the cafes were 'attended v.ith iV
den red fuccefs.

The cafes in which thefe large injecHcns are moft nfeful, nre tlu-.^c
in which hardened fasces are accumulated in the cohn. The wrA
water anfweris two intentions, viz. dilating the paffj^e, and f
ing the fa?ces.

§ In the early (hges of this'difcafe, the be:ly is to be krpt op;-n
by the mildeft laxatives, and a milk diet ftriaiy 'uf.-J. The- fellow-
ing formula anfwers extremely well ;

PRACTICE

In the form of a colic, my want of experience concern*
ing it does not allow .me to fpeak with any confidence
on the fubject ; but, fo far -as I can learn from others,
it appears to me, that it is to be treated by all the fe~
veral means that I have propofed above for the cure of
colic in general.

How far the peculiar effeds of this difeafe are to be
certainly forcfeen and obviated, I have not properly
learned ; and I muft leave the matter to be determin-
ed by thofe who have hadfufficient experience in it.

C K A P. X.

OF THE CHOLERA,

MCCCCLIII.

fN this difeafe, a. vomiting and purging concurring
together, or frequently alternating with one another,
-:e the chief fymptoms. The matter rejecled both
upwards and downwards appears manifeftly to confift
chiefly of bile.

MCCCCLIV.

From this lad circumftance I conclude, that the
difeafe depends upon an increafed fecretion of the
bile, and its copious effufion into the alimentary ca-
nal • and, as in this it irritates and excites the mo-
tions

% Mannsc.
* Ol. olivar. a a Ji.

M. f. Linclus.

TIiJs quantity is a proper dofe, and it may be repeated every day
with thirty or forty drops of laudanum at bed-time. If the fymp-
toms, however, do not abate, vvs may (at the fame time,) give
large emollient clyfters.

OF PHYSIC. 223

tions above mentioned, I infer, that the bile thus ef-
fufed in larger quantity is at the lame time alfo of a
more :ic.id quality. This appears like wife from the
violent and very painful gripings that attend the dif-
eafe, and which we can impute only to the violent
fpafmcdic c. mrncYions of the inteftines that take place
here. Thefe ipafms are commonly communicated to
the abdominal mufcles, and very frequently to thofe
cf the extremities.

MCCCCLV.

In the manner now defcribed, the difeafe frequent-
ly proceeds wiih great violence, till the ftrength ot
the patient is greatly, and often fuddenly weakened ;
while a coldnefs of the extremities, cold fweats, and
faintings, coming on, an end is put to the patient's
life, L-me times in the courfe of one day. In other
cafts the difeafe is lefs violent, continues for a day or
two, and then ceafes by degrees ; though fuch reco-
veries feldom happen without the affifiance of reme-
dies.

MCCCCLVI.

The attacks of this difeafe are feldom accompanied
with any fymptoms of pyrexia : and though, during
the courfe of it, both the pulfe and refpiration are
hurried and irregular, yet thefe fymptoms are gene-
rally fo entirely removed by the remedies that quiet
the ipafmodic affe&ions peculiar to the difeafe, as to
leave no ground for fuppofing that it fcad been accom-
panied by any proper pyrexia.

MCCCCLVII.

This is a difeafe attending a very warm ftate of the
air ; and in very warm climates, it may perhaps ap-
pear at any time of the year : but even in fuch cli-
mates it is mod frequent during their warmed feafons >
*and in temperate climates, it appears only in the
warm feafons. Dr. Sydenham confidercd the appear-
ances of this difeafe in England to be confined to the

month

224 PRACTICE

month of Augud ; but he himfelf obferved it to ap-
ptar funietiii.es towards the end of iuinmer, when the
feafon was liiiu/l^lly vvaim ; and that, in proportion to
the heat, the violence of the difeafc was greater. —
Otheis have obferved that it appeared more early in
fummer, and always fooner or later, according as the
great heats IOCIKT or later fet in.

MCCCCLVIII.

Fiom all thefe circumftances, it is, I think, very
evident that this difeafe is the effect of a warm atrnof-
phere, producing fome change in the flate of the bile
in the human body ; and the change may confift, ei-
ther in the matter of the bile being rendered more
acrid, and thereby fitted to excite a more copious fe-
cretk,n ; or, in the faa:e matter, its being prepared to
pafsoifin larger quantity than ufual.

MJCCCLIX.

It has been remarked, that in warm climates and
feafons, after extremely hot and dry weather, a fall of
rain cooling the atmofphcre feems cfpecially to bring
on this difeafe ; and it is vciy probable that an ob-
ilvucled penpiration may have a!f) a fnare in this,
though it is alfo certain that the difeafe does appear
when no change in the temperature of the ah 3 nor any
application oi cold, has been obferved.

MCCCCLX.

It is poflible, that, in fome cafes, the heat of the
feafon may ^ive only a predifpoiition, and that the
difeafe may be excited by certain ingefta or other cauf-
es ; but it is equally certain, that the difeafe has occur-
red without any pieviuus change or error, either in
diet, or in the manner c,f life, that could be obferved.'

MCCCCLXi.

The Nofologifts have conilitutcd a Genus '*nacr
tl.e title of Cholera, and under this have arranged as
fpecies, every affection in which a vomiting ancl purg-
ing of any kind happened to concur. In many of

thefe

OF PHYSIC. 225

thefe fpecies, however, the matter evacuated is net bi-
lious ; nor does the evacuation proceed from any
caufe in the (late of the atmofphere. Further, in ma-
ny of thefe fpecies alib, the vomiting which occurs is
not an efll-ntial, but merely an accidental, fyrnptom
from the particular violence of the difeafe. The ap-
pellation <f Cholera therefore fhouid, ia my opinion^
be confined to the difeafe I have d.fcribed above ;
which by its peculiar caufe, and perhaps alfo by its
fymptoms, is very different from all the other fpecies
that have been ailbciated with it. I believe that all
the o'her fpecies arranged under the title of Cho-
lera by Sauvages or Sigar, may be properly enough
referred to the genus of Diarrhoea ; which we are to
treat of in the nexUphapter.

The diftinciion I have endeavoured to eftabliih be-
tween the proper Cholera, and the other difeafes that
have fornetimes got the fame appellation, will, as I
judge, fuperfede the queftion., Whether the Cholera,
in temperate climates, happens at any other feafoh
than that above afligned ?

MCCCCLXIL

In the cafe of a genuine cholera, the cure of it has
been long eftabiiflicd by experience.

In the beginning of the difeafe, the evacuation of
the redundant bile is to be favoured by the plentiful
exhibition of mild diluents*, both given by the mouth,
and injected by the anus ; and all evacuant medicines,
employed in either way, are not only fuperfiuous, but
commonly hurtful.

MCCCCLX11L

When the redundant bile appears to be fufficiently
warned out, and even before that, if the fpafmodic af-

VOL. II. F f fedions

f Thin rice-gruel is as proper a mild diluent as any we can ufe :
as is rtlio water in which a cruft of bread is boiled. A very fmall
quantity of port wine may be added to tliefe diluents if the puJfe K-
iniali or weak.

226 PR AC T I C E

feclroirs of the alimentary canal become very violeniy
and are communicated in a considerable degree to other
pa.ta of the body, or when a dangerous debility feems
to be induced, the irritation is to be immediately
obviated oy opiates in iufficiently large dofes, but
in fniall bulk, and given either by the mouth, or by
glvikr*.

MCCCCLXIV.

'Though the patient be in this manner relieved, it
frequently happens, that when the operation of the opi-
um is over, the dileafe mows a tendency to return 5
and, for at lead fome days afrer the firft attack, the ir-
ritability of the inteftines, and their difpolition to fall
into painful fpafmodic contractions, feem to continue.
In this iituation,the repetition of the opiates, for perhaps
ieveral days, may come to be necerTary ; and as the
debility commonly induced by the difeafe favours the
difpoiitron to fpafmodic affections, it is often ufeful and
neceifary, together with the opiates, to employ the to-
nic powers of the Peruvian bark§.

C H A P.

* A pill confiding of a grain of opium may be given every two'
hours, and if it does not relieve the fymptoms after the third OF
fourth repetition, we may injeA the follbwing glyiler :
§,. Decoa. Hord. |x.
Tin it. Thebaic. 3ii.
M. f. Enema.

This clyfter may be repeated twice, or thrice if there be occafion.
§ The bark in thefe cafes, is ofteii fuccefsfully given along with
rhubarb, as in the following formula :

P.. Pulv. Cort. Peruv, Jfs.
Rad, Khei. ^i.

M. f. lulv. in part. JEqual. xii. dividend.

One of thefe powers may he given thi'ee times a day with »
glafsof port \vi;:-.

OF P.H Y S I C. 227

C II A P. XI.

OF DTARRHCEA OH LOOSEME^S, '

MGCCCLXV.

I^HIS difeafe confifls in evacuation by itocl, more
frequent and of more liquid matter drin ufual.
This leading and characteriftic fymptom is io diverfi-
iied in its degree, in its cauies, and in the variety of
matter evacuated, that it is al-noil impolitic io give
any general hiftory of the difeafe.

'MCCCGLXVI.

It is to be diflinguifhed from dy fernery, by not be-
ing contagious ; by being generally without fever ;
and by being with the evacuation of the natural ex-
crements, which are, at lead for fometime, retained
in dyfentery. The two difeafes have been commonly
uiftinguifhed by the gripings being more violent in
the dyfentery ; and they are commonly leis violent
and leis frequent in diarrhoea : but as they frequently
do occur in this alfo, and ibmetimes to a confiderable
degree, fo they do not afford any proper diiiiiittion*.

MCCCCLXVJI.

A diarrhoea is to be difting uiflied from cholera
y by the difference of their caufes ; which, in
cholera, is of one peculiar kind ; but in diarrhoea is
prodigioufly diverfified, as we fliall fee pvefcrntiy. It
has been common to dtftinguifh cholera by tlie eva-
cuation downwards being of bilious matter, and by
this being always accompanied with a v. nv'ting of the
lame kind ; but it does not univerfally apply, '^ a tliar-

Ff2

* TencfmiTs is a el ifi ing mfhlng fymptom of dyfeiitfry, but it is
fotnetimcs piefent in diarrhoea alfo; efpecidliy tivofe
which proceed from acjTo cr putrid fubftances in the ttUefline*.

228 PRACTICE

rhoea is fometimes attended with vomiting, and even
of biiious matter.

MCCCCLXVIII.

The difeafe of diarrhoea, thus diftinguifhed, is very
greatly diveriified ; hut in all cafes, the frequency of
ilobls is to be impured to a preternatural increafe of the
periftaitic motion in the whole, or at kaft in a confi-
derable portion, of the inteftinal canal. This increaf-
ed action is in different degrees, is often convulfive and
fpafmodicy and .at any rate is a motus abnormis : for
which reafon, in the Methodical Nofblogy, I have re-
ferred it to the order of Spafmi> and accordingly treat
of it in this place.

MCCCCLX1X.

Upon the fame ground, as I confider the difeafe
named Lientcry to be an increafed perifiaitic motion
over the whole of the inteflinal canal, arifing from a
peculiar irritability, I have confidered it us merely a
j'pecies of diarrhoea.. The idea of a laxity of the in-
tciiinal canal being the caufe either of lientcry, or
other fpecies of diarrhoea, appears to me without foun-
dation, except in the fmgle cafe of frequent liquid
ilools from a palfy of the fphinfter ani.
MCCCCLXX.

The increafed action of the periftaitic motion, I con-
fider as always the chief part of the proximate caufe
of diarrhoea : but the difeafe is further, and indeed
chiefly, diveriificd by the different caufes of this in-
creafed a&ion y which we are now to inquire into.
MCGGCLXXI.

The fever.il caufes of the increafed aclion of the in-
teftiues may beTcferred, I think, in the firil place, to
two general heads.

Thcjzr/t is, of the difeafes of certain parts of the
.body which, either from a confent of the interlines
with thefe parts, or from the relation which the iiuef-
tines have to the whole fyftcm, occafion an increafed

action

OF PHYSIC. 229

action in the inteftiries, without the transference of
any ftimulflnt matter from the primary difeaied pare
to them.

The fee on d head of the caufes of the increafed ac-
tion of the interlines is the ilimali of various kinds,
which are applied directly to the inteftines tbemlelvcs.
MCCCCLXXil.

That affections of other parts of the fyflem may
afFecl: the inteftines without the transference or ap-
plication of any ftimulant matter, we learn from hence
that the paffions of the mind do in fome perfons excite
diarrhoea.

MCCCCLXXI1L

That difeafes in other parts may in like manner af-
'fecl the inteftines, appears from the dentition of in-
fants frequently exciting diarrhoea. I be'ieve that the
gout often affords another inftince of the fame kind ;
and probably there are others aifo, though not well
afceruined.

MCCCCLXXIV.

The flimuli (MCCCCJLXXI.) which may be applied
to the inteftines are of very various kinds j and are ei-
ther,

1. Matters introduced by the mouth.

2. Matters poured into the inteftines by the feveral
excretories opening into them.

3. Matters poured f:orn certain preter-natural open-
ings made into them in certain difeafes.

MCCCCLXXV,

Of thole (MCCCCLXXIV, i.) introduced bv t!;~
mouth, the fir ft to be mentioned are the aliments
commonly taken in. Too great a quantity oft'
taken in, often prevents their due digeflion in the flc?-
mach ; and by being thus fent in their crude, and 'pro-
bably acrid, Itate to the inteftines, they frequently ex-
cite diarrhoea.

The fame aliments, though in proper quantity,

ha

PRACTICE

having too great a proportion, as frequently happ;
of faline or iaccharine matter along with them, prove
ftimalant to the int:f!ines, and excite diarrhoea.
• Bat our aliments prove efpecially the caufes of di-
arrhoea, according as they, from their own nature, or
from the weakneis of the ilomach, are difpofed to un--
clergo an undue degree of fermentation there, and
thereby become (liraulant to the inteilines. Thus
acefcent aliments are ready to produce diarrhoea ; but
whether from their having any direclly purgative qua-
lity, or only as mixed in an over proportion with the
bile, is not well determined.

MCCCCLXXVI,

Not only the acefcent, but aJfo the putrefcent dif-
poiiiionof the aliments, feems to occafion a diarrhoea;
and it appears that even the efiluvia of putrid bodies,
taken in any way in large quantity, have the fame cf-

Are oils or fats, taken in as a part of our aliments,
ever the caufe of diarrhoea ? and if fo, in what manner
do they operate* ?

MGCCCLXXVII.

The other matters introduced by the mouth, which
may be caufes of diarrhoea, are thofe thrown in either
as medicines, or poifons that have the faculty of Simu-
lating the alimentary canal. Thus, in the lift of the
Materia Medica, we have a long catalogue of thofe
named purgatives; and in theliit of puiions, we have
many pofieffed of the fame quality. The former,
j'iven in a certain quantity, occaiion a temporary di-
anhcEj ; and given in very large dofes, may occafion
it in excefs, and continue it longer than uiual, produ-
cing that fpccies of diarrhoea named a Hypercatharlis.

MCCCCLXXVilL

* Rancid o3s and fats ccrtaJaly irsriutc t!ie iateitines; anJ m;jy
r. ire pro-dace

6 F P H Y S I C. 231

MCCCCLXXVIII.

The matters (MCCCCLXXIV, 2.) poured into the cavi-
ty of the inteftines from the excretories opening into
them, and which may occafion diarrhoea, are either
thofe from the pancreatic or biliary duel, or thofe
from the excretories in the coats of the inteftines
themfelves.

MCCCCLXXIX.

What changes may happen in the pancreatic juice/
I do not exadly know ; but I fuppofe that an acrid
fluid may iflue from the pancreas, even while ftiil en-
tire in its ftruchire ; but more efpecially when it is in a
fupporatcd, fcirrhous, or cancerous ftate, that a very
acrid matter may be poured out by the pancreatic
duel:, and occafion diarrhoea.

MCCCCLXXX.

We know well, that from the biliary duel: the bile
may be poured out in greater quantity than ufual; and
there is little doubt of its being alfo fometimes pour-
ed out of a more than ordinary quality. It is very
probable, that in both ways the bile is frequently s
caufe of diarrhoea.

Though I have faid above that diarrhoea may be
commonly d 1 fling ui /lied from cholera I mult admit
here, that as the caufes producing that Hate of the
bile which occafions cholera, may occur in all the dif-
ferent poilible degrees offeree, fo as, on one occasion*
to produce the mod violent and diftirictJy marked
cholera ; but, upon another, to produce only the gen-
tled diarrhoea : which, however, will be the fame dif-
eafe, only varying in degree : So I think it probable^
that in warm climates, and in warm feafons, a diar-
rhoea bih of a of this kind may frequently occur, not to
be always certainly diitinguifhed from cholera.

However this may be, it is fufficiently probable,
that, in fome cafes, the bile, without having been act-
ed upon by the heat of the climate or feafon, may be

redundant

332 PRACTICE

redundant and acrid, and prove therefore a particular
caufe of diarrhoea.

MCCCCLXXXI.

Bcfide bile from the feveral canfes and in the con-
ditions mentioned, the biliary duel: may pour out pus,
or other matter from abfcefles in the liver, which may
be the caufe of diarrhoea.

Practical writers take notice of a diarrhoea wherein
a thin and bloody liquid is difchargecl ; which they
fuppofe to have proceeded from the liver, and have
therefore given the difeafe the name of Hepatirrhoea :
but we have not met with any initance of this kind ;
and therefore cannot properly fay any thing concern-
ing it.

MCCCCLXXXir.

A fecond fet of excretories, from which matter is
poured into the cavity of the interlines, are thofe
from the coats of the intcflines themfelves ; and are ei-
ther the exhalants proceeding directly from the extre-
mities of arteries, or the excretories from the mucous
follicles : and both thefe fources occur in prodigious
number over the internal furface of the whole intend-
nal canal. It is probable that it is chiefly the effufion
from thefe fources which, in m-jfl inflances, gives the
matter of the liquid (tools occurring in diarrhoea.
MCCCCLXXX11I.

The matter from both fources may be poured out
in larger quantity than ufual, merely by the increafed
action of the inteftines, whether that be excited by
the paflions of the mind (MCCCCXXII.) by difeafes in
other parts of the fyflem (MCCCCLXXI, i.) or by the
various ftimulants mentioned MCCCCLXXV. and follow-
ing; or the quantity of matt; r poured out may be in-
creafed, not ib much by the increafed action of the in-
teftines, as by an increafed afflux of fluids from other
parts of the fyflem.

Thus, cold applied to the furface of the body, and

fupprefling

OF PHYSIC; 233

fuppreffing perfpiration, may determine a greater
quantity of fluids to the intettines.

Thus, in the ifchuria renatis^ the urine taken into
the blood-veflels is fometimes determined to pafs off
again by the interlines.

In like manner, pus or fertim may be abfbrbed from
the cavities in which they have been ftagnant, and
be again poured out into the inteftines, as frequently
happens, in particular with refpett to the water of
dropiies.

MCCCCLXXXIV.

It is to be obferved here, tbat a diarrhoea may be
excited not only by a copious afflux of fluids from
other parts of the iyftem, but likewife by the mere
determination of various acrid matters from the mafs of
blood into the cavity of the interlines. Thus it is fup-
pofed that the morbific matter of fevers is fometimes
thrown out into the cavity of the interlines, and
gives a critical diarrhcea : and whether I do or do not
admit the doctrine of critical evacuations, I think it
is probable that the morbific matter of the exanthe-
mata is frequently thrown upon the inteflines, and
occasions diarrhoea.

MCCGGLXXXV.

It is to me further probable, that the putrefcent
matter diffufed in the mafs of blood in putrid difeafes?
is frequently poured out by the exhalants into the in-
teftines, and proves there the caufe, at lead in part, of
the diarrhcea fo commonly attended with thefe dif-
eafes.

MCGCCLXXXVL

Upon this fubjjecl of the matters poured into the ca-
vity of the interlines, I have chiefly confidered them
as poured out in unufual quantity, but it is probable
that, for the mod part, they are alfo changed in their
quality, and become of a more acrid and liimulantna-

VOL. II. G g ture;

PRACTICE

tuve ; upon which account efpecially it is that the/
excite, or at leuft increafe, a diarrhoea.
MCCCCLXXXVIL

How far, and in what manner, the exhalant fluid
may be changed in its nature and quality, we do not
certainly know : but with refpecl to the fluid from
the mucous excretories, we know, that, when poured
out in unufual quantity, it is commonly, at the fame
time, in a more liquid and acrid form ; and may prove,
therefore, confiderably irritating,

MCCCCLXXXVIII.

Though the copious efFulion of a more liquid and
acrid matter from the mucous excretories, be proba-
bly owing to the matter being poured out immediate-
ly as it is fecreted from the blood into the mucous fol-
licles, without being allowed to ilagnate in the latter,
fo as to acquire that milder quality and thicker con-
fidence we commonly find in the mucus in its natural
ftate; and although we might fuppofe that the excre-
tions of a thin and acrid fluid mould always be the ef-
fect of every determination to the mucous follicles,
and of every flimulant applied to them : yet it is cer-
tain, that the reverfe is fometimes the cafe ; and that-,
from the mucous follicles, there is frequently an in-
creafed excretion of a mucus, which appears in its
proper form of a mild vifcid, and thickim matter.
This commonly occurs in the cafe of dyfentery ; and
it has been obferved to give a fpecies of diarrhoea,
which has been properly named the Diarrhoea Mucvfa*
MCCCCLXXXIX.

A third fotirce of matter poured into the cavity of
the interlines, and occaiioning diarrhoea (MCCCC-
LXXIV, 3.) is from thole preternatural openings pro-
duced by diieafes in the interlines or neighbouring
parts. Thus the blood-vefTels on the internal furface
of the mteftines may be opened by erofion, rupture,
or anaflomofis, and pour into the cavity their blood,

which,

OF PHYSIC. 235

•which, either by its quantity or by its acrimony, whe-
ther inherent, or acquired by Itagnation, may fome.
times give a diarrhoea evacuating bloody matter. This
is what I think happens in that difeafe which has
called the Melcena or Morbus Niger.
MCCCCXC.

Another preternatural fource of matter poured in-
to the cavity of the inteitines, is the rupture of abfcef-
fes feated either in the coats of the interlines them-
felves, or in any of the contiguous vilcera, which, du-
ring an inflamed flate, had formed an adhefipn with
fome part of the interlines. The matter thus poured
into their cavity may be various ; purulent, or fanious,
or both together, mixed at the fame time with more
or lefs of blood ; and in each of thefe ftates may be a
caufe of diarrhoea.

MCCCCXCI.

Amongft the ftimuli that may be directly applied to
the interlines, and which, by increaiing their periftal-
tic motion, may occafion diarrhoea, I mud not omit
to mention worms, as having frequently that effect.
MCCCCXCH.

I muft alfo mention here a ftate of the interlines,
wherein their periftaltic motion is preternaturally in-
creafed, and a diarrhoea produced ; and that is, when
they are affected with an erythematic inflammation.
With refpect to the exiflence of fuch a ftate, and its
occasioning diarrhoea, fee what is faid above in ccc-
xcvm. and following. Whether it is to be confcder-
ed as a particular and diftinct cafe of diarrhoea, or is
always the fame with fome of thofe produced by one
or other of the caufes abo/e mentioned, I have not
been able to determine.

MccccxciiF.

Laftly, by an accumulation of alimentary or of o-
ther matter poured in the cavity of the inteftines from
feveral of the fources above mentioned, a diarrhcea

G g 2 may

236 PRACTICE

may be efpecially occasioned when the abforprion of
the lacteals, or of other abforbents, is prevented, ei-
ther by an obftruction of rheir orifices, or by an ob-
ftruction of the mefenteric glands, through which
alone the abforbed fluids can be tranfmirted.

In one inftance of this kind, when the chyle pre-
pared in the ftomach and duodenum is not abfoibed in
the courfe of the inteftines, but paffes off in confidera-
ble quantity by the anus, the difeafe has been named
Morbus Cce/iaca^ or limply and more properly Coe/iaca;
which accordingly I have conlidered as a fpecies of
diarrhoea.

MCCCCXCIV.

I have thus endeavoured to point out the various
fpecies of difeafe that may come under the general
appellation of Diarrhoea ; and from that enumeration
it will appear, that many, and indeed the greater part
of the cafe of diarrhoea, are to be coniidcred as fympa-
thetic affections, and to be cured only by caring the
primary difeafe upon which they depend ; of which,
however, I cannot properly treat here. From Our1
enumeration it will alfo appear, that many of the ca-
fes of diarrhoea which may be confidered as idiopa-
thic, will not require my laying |nuch of them here.
In many instances, the uiieaie is afcertained, and alfo
the cauieailigned, by the condition of the matter e-
vacuated ; fo that what is neceilary to correct or re-
move it will be fufficiently obvious to practitioners of
any knowledge. In ihoit, I do not find that lean of-
fer any general plan for the cure of diarrhoea ; and
all that I can propoie to do on this fubject, is to give
Ibme general rem irks on the practice that has been
commonly followed in the cure of this difeafe.
MCCCCXCV.

The practice in nis difeafe has chiefly proceeded
upon the fupp^fition or an acrimony in the fluids, or
of a laxity in the fimpie and moving fibres of the in-
teftines;

O F P H Y S I C. 237

; and the remedies employed have according-
ly been Correctors of particular acrimony, general
demulcents, evacuants by vomiiing or purging, af-
tringents, or opiates. Upon each of thefe kinds of
remedy 1 mail now offer fome remarks.
MGCCCXCVI.

An acid acrimony is, upon feveral occalions, the
caufe of diarrhoea, particularly in children ; and in
fuch cafes the abforbent earths have been very proper-
ly employed. The common, however, and promif-
cuous ufe of thefe has been very injudicious ; and
where there is any putrefcency, they mud be hurtful.
MCCCCXCVII.

The cafes in which there is a putrid or putrefcent
acrimony prevailing, have been, I think, too feldom
taken notice of; and, therefore, the ufe of acids too
feldom admitted. The acrimony to be fufpeded in
bilious cafes, is probably of the putrefcent kind,
MCCCCXCVIII.

The general correctors of acrimony are the mild
diluents and demulcents. The former have not been
fo much employed in diarrhoea as they ought ; for,
joined with demulcents, they very much increafe the
effects of the latter : and although the demulcents,
both mucilaginous and .oily, may by themfelves be
ufeful, yet without the affiftance of diluents they can
hardly be introduced in fuch quantity as to anfwer the
purpofe*.

MCCCCXCIX.

* Lintleed-tea is both diluent and demulcent ; but as the patient
fometimes loaths it, we may in its place ufe a deception of inarfh-
m allows root, or of quince feed. Thefe mfufions and decoctions
ought to be extremely thin. An ounce of bruifed quince-feed will
make three pints of water as thick and ropy as the white of an egg j
hence a drachm is fufficient for a pint of the decoction,

We have another inf'ance of a diluent and demulcent in the al-
mond emulhon. which is an exceedingly elegant medicine. The
formulae in both the L,ondon and Edinburgh Pharmacopoeias are not
Well adapted to cafes of diarrhoea : for the former contains fugar,

PRACTICE

MCCCCXCIX.

As indigeilion and crudities pr.efent in the flora ack
are io often the caufe of diarrhoea, vomiting mud
therefore be frequently very ufeful in this difeaie.

In like manner, when the difeafe proceeds, as it oft-
en does, from obflrucled perfpiration, and increafed
afflux of fluids to the interlines, vomiting is perhaps
the mofi effectual means of reftoring the determina-
tion of the fluids to the ftirface of the body.

It is poilible alfo, that vomiting may give fome in-
verfion of the periilaltic motion which is determined
too much downwards in diarrhcea ; fo that up9n the
whole it is a remedy which may be very generally ufe-
ful in this difeafe*.

MD.

Purging has been fuppofed to be more univerfally
necelTary, and has been more generally practifed.
This however, in my opinion, proceeds upon very mif-
taken notions with refpecl to the difeafe ; and fuch a
practice feems to me for the moft part fuperfluous, and
in many cafes very hurtful It goes upon the fuppo-
fition of an acrimony prefent in the inteftines, that
ought to be carried out by purging : but, if that acri-'
mony has either been introduced by the mouth, or
brought into the inteftines from other parts of -the
body, purging can neither be a means of correcting
nor of exhaulling it ; and muft rather have the effecl
of indenting its afflux, and of aggravating its effects.

From

and the latter oitter almonds ; both of which increafe the irritation.
In thefe cafes, therefore, an emulfion made with fwcet almonds and
gum arabic, is preferable to either of the others : as,
%>. Arnygdal. dulc. decorticat. 31*.

Gum Arabic. 31.

Tere in mortario marmoreo, et addc gradatim.

Aq. font. Ib. i.

M.f. Emulf.

* The methods of giving the tartar emetic, for producing cither
vomiting or fwcating, may be fccn in the notes on article 185,

OFF II Y S I C.

From whatever fource the acrimony which can excite
a diarrhoea proceeds, it may be fuppofed fufficient to
evacuate itfelf, fofaras that can be done by purging ;
and as in cholera, fo in the fame kind of diarrhoea, it
will be more proper to aflift the evacuation by diluents
and demulcents, than to increafe the irritation by pur-
gatives,

MDI.

If, then, the ufe of purgatives in diarrhoea may be
confidered, even when an acrimony is prefent, as fu-
peril uous, there are many other cafes in which it may
be extremely hurtful. If the irritability of the intef-
tines mail, from affections in other parts of the fyftem,
or other caufes, have been already very much increaf-
ed} purgatives muft neceiiarily aggravate the difeafc,
In the cafe of lientcry, nobody thinks of giving a pur-
gative ; and in many cafes of diarrhoea approaching
to that, they rnuft be equally improper. I have al-
ready obferved, that when diarrhoea proceeds from an
afflux of fluids to the interlines, whether in too great
quantity, or of an acrid quality, purgatives may be
hurtful ; and whoever, therefore, conriders the nu-
merous and various fources from which acrid matter
may be poured into the cavity of the interlines, will
readily perceive, that, in many cafes of diarrhcea, pur-
gatives may be extremely pernicious.

There is one cafe in particular to be taken notice
of. When, from a general and acrid diifolution of
the blood, the ferous fluids run off too copiotiily into
the cavity of the inteftines, and excite that diarrhoea
which attends the advanced flate of heclic fever, and
is properly called a Colliquative Diarrhoea ; I have, in
fuch cafes, often feen purgatives given with the. moil
baneful effects.

There is flill another cafe of diarrhoea in which
purgatives are pernicious ; and that is, when the dif-
eafc dependsj as we have alledged it forr.etimes may
upon an erythematic inflammation of the interlines.

I need

240 PRACTICE

I need hardly add, that if there be acafe of diarrhcea
depending upon a laxity of the folids, purgatives can-
not there be of any iervice, and may do much harm.
Upon the whole, it will, I think, appear, that the ufe
of purgatives in diarrhoea is very much limited; and
the promifcuous life of them, which has been fo com-
mon, is injudicious, and often pernicious. I believe
the practice has been chiefly owing to the ufe of
purgatives in dyfenteric cafes, in which they are truly
ufeful ; becaufe, contrary to the cafe of diarrhoea, there
is in dyfcntery a coniiderable conftri&ion of the intef-
tines*.

MDIL

Another fet of remedies employed in diarrhoea are
aftringents. Tfrere has been fome heiitation about
the employment of thefe in recent cafes, upon the
fuppoiition that they might occaiion the retention of
an acrid matter that fhouid be thrown out. I cannot,
however, well underfland or aflign the cafes in which
fuch caution is neceflary ; and I think that the power
of ailringents is feldom fo great as to render their ufc

very

* Notwithstanding all the author advances concerning the danger
of purgatives in a dianhcsa, there are fome cafes in which they are
of fingular utility. His arguments in this article are doubtlefs
iuft ; and, in the fpecies of diarrhcea which he here enumerates, pur-
g-atives arc certainly hurtful : but many inftances of diarrhoea occur,
which proceed from an acrimony that is extremely tenacious, and
that adheres clofely to the internal furface of the intelline*, or is re-
tained in their folds. In fuch cafes, purgatives are the only re-
medies for removing the difeafe, and ought therefore to be uft d. In
ail other cafes, (as the author jultly obferves,) they are certainly
pernicious.

Having afcertained when purgatives are proper, the next confi-
oeration is, what purgatives ought to be ufcd ? The anf\ver is obvi-
ous : — Neutral falts, particularly ^oda phofphorata, Rochel Salt,
Glauber's falts, and Epfora ia!t, which are enumerated in the order
of their being agreeable, but' in a contrary order to their degree
of efficacy; the E^'V-ni idlt being the kail agreeable, but lhs
inoil tiiic.'.clous.

OF PHYSIC. 241

•

very dangerous. The only difficulty which has occur-
red to me, with refpecl to their ufe, has been to judge of
the circumftances co which they are efpecially adapt-
ed. It appears to me to be only in thofe where the
irritability of the inteflines depends upon a lofs of
tone : and this, I think, may occur either from the
debility of the whole fyftem, or from cauies acling on
the interlines alone. All violent or long-cominued
fpafmodic and convullive affe&ions of the imeitinai
canal neceffarily induce a debility there; and fuch
caufes often take place, from violent irritation, in co*
lie, dvfentery, cholera, and diarrhoea*.

MDiII.

The laft of the remedies of diarrhoea that remain to
VOL. II. H h be

* The aftringcnts to be ufed when they arc proper, are various c-
as Alum, Logwood, Catechu, Rhubarb, &c. The author juftly
remarks, that aftringents are only ufeful in cafes of debility, and
therefore the tonic aftringents.are undoubtedly preferable to any
other. Rhubarb and Peruvian bark, each poifeffihg both thefe qua-
lities, may therefore be advantageoufly ufed conjointly, as in the
following formula :

5.. Pulv. Cort. Peruv. §i.
Rad, Rhei, gfs.
M. f. Pulv.

The dofe of this powder may be varied according to circumflances,
from a fcruple to a dram, twice a-day, with a glafs of port wine
after it.

It may not be improper to obferve, that in diarrhoeas in general
peculiar attention muft be paid to diet. The oleraceous and acef-
cent vegetables muft be carefully avoided ; as muft alfo all fermented
liquors except port wine ; of the farinaceous vegetables, rice is the
belt ; arid rice-water, with a little cinnamon and port wine, is the
moll proper drink for patients in thefe cafes. Roafted meats are
preferable to boiled ; and veal, lamb, or chickenF,preferable to beef
or mutton. Pork is very improper, as are alfo all kinds of fifh.
Puddings of ail kinds without fruit are very proper food for fuch
patients, efpecially rice-puddings made without eggs, but with milk
and cinnamon ; and alfo rice- milk, fago with port wine, blanc
mange, &c.

P R A C T I C E

be mentioned are opia'e?. The fame objections have'
been made to the ufe -of thefe,-in recent cafes of diar-
rhoea, as to that rf aftringents ; but on no good
grounds : for the effect of opiates, as aftringent, is ne-
ver very permanent ; and an evacuation depending
upon irritation, though it may be for foaie thnefuf-.
pended by opiates, yet always returns very foon. It
is only by taking off irritability that opiates are ufeful
in diarrhoea; and therefore, when the diieafe depends
upon an increafe of irritability alone, or when, though
proceeding from irritation, that irritation is corrected
or exhausted, opiates are the moil: ufeful and certain-
remedy. And thoughopiates are not fuited to correct
or remove an imraiionapplied, they are often of great
benefit in fufpending the effects of that irritation
whenever theie are violent : and, upon the whole,
it will appear, that opiates "may be very frequently,
and with great propriety, employed in the cure of
diarrhcea.

T

C H A P. XII.

O F T HE DIABETES.

MDIV.

HIS difeafe confifts in the voiding of an

large quantity of urine.

As hardly any fecvetion can be increafed without
an increafed Action of the vefTels concerned in it, and
as forne inilances of this difeafe are attended with affec-
tions manifeflly fpafmodic, I have had no doubt of
arranging the diabetes under the order of Spafmi.

MDV.

This difeafe is always accompanied with a great de-

gree

O I' 'P H Y S I C. 243

grce of thiril, and therefore with the taking in of a
great quantity of drink. This in fome meafure ac-
counts for the very extraordinary quantities of urine
voided: but fall, independent of this, peculiar dif-
eafe certainly takes place; as the quantity of urine
voided does»almoil always exceed the whole of the
liquids, and fomttiraes ihe whole of both folids and li-
quids, taken in..

MBW,

The urine voided in this difcafe is always very clear,
and at fir ft fight appears entirely wiih^m any colour :
but, viewed in a certain light, it generally appears
to be flightlyv tinned with a yeliowifl} green, and
in thi^ refpecl has been very properly compared to a
folution of honey in a large proportion of water.

Examined by the tafte, it is very generally found
to be more or lefs fweet ; and many experiments that
have now been made in different inftances of the dif-
eafe, fhow clearly that fuch urine contains, in confider-
able quantity, a faccharine matter which appears to be
very exactly of the nature of common fugar.

MDVIL

Dc&or Willis feems to me to have been the firiv
who took notice of the fweetnefs of the urine in dia-
betes, and almoft every phyfician of England has fince
taken notice of the fame. It is to be doubted, indeed,
if there is any cafe of idiopathic diabetes in which the
urine is of a different kind. Though neither the an-
dents, nor, in the other countries of Europe, the mo-
derns, till the latter were direcled to it by the Englifh,
have taken notice of the fweetnefs of the urine, it does
not perfuade me, that either in ancient or in modern
times the urine in diabetes was of another kind. I
myfelf, indeed, think I have met with one inftance
of diabetes in which the urine was perfectly infipid ;
and it would feem that a like obfervation had occur-
red to Dr. Martin Lifter. I am perfuaded, however,
H h 2 that

344 PRACTICE

that Rich inflances are very rare ; and that the other
is by much the more common, and perhaps the al-
rnoft univerfal occurrence. I judge, therefore, that
the prefence of fuch a faccharine matter may be con-
fidered as the principal circumftance in idiopathic di-
abetes ; and it gives at leaft the only cafeaof that dif-
eafe that I can properly treat of here, for I am only
certain that what I am further to mention relates to
fuch a cafe.

MDVIIL

The antecedents of this difeafe, and confequently
the remote caufes of it, have not been well afcertain-
ed. It may be true that it frequently happens to men
who, for a long time before, had been intemperate in
drinking ; that it happens to perfbns of a broken con-
ftitution, or who, as we often exprefs it, are in a
cachecYic ftate ; that it fometirnes follows intermit-
tent fevers ; and that it has often occurred from excefs
in the drinking of mineral waters. But none of thefe
caufes apply very generally to the cafes that occur:
fuch cafes are not always, nor even frequently, fol-
lowed by a diabetes ; and there are many inftances of
diabetes which could not be referred to any of them,
In mod of the cafes of this difeafe which I have met
with, I could not refer it to any particular caufe.

MD1X.

This difeafe commonly comes on flowly, and almoft
imperceptibly, without any previous diforder. It of-
ten rifes to a coniiderable degree, and fubfifts long
without being accompanied with evident diforder in
any particular part of the fyftem. The great third
\vhich always, and the voracious appetite which frer
quently occurs in it, are often the only remarkable
fymptoms. Under the continuance of the difeafe, the
body is often greatly emaciated ; and a great weak-
nefs alfo prevails. The pulfe is commonly frequent ;
and an obfcure fever is for the moft part prefent. —
When the difeafe proves fatal, it generally ends with

a fever

OF PHYSIC. 245

a feve'r, in many circnmflances, particularly thofe of
emaciation and debility, refembling a hectic:

MDX.

The proximate caufe of this difeafe is not certainly
or clearly known. It feems to have been fometimes
connected with calculous affections of the kidneys ; and
it is poffible, that an irritation applied there may in-
creafe the fecretion of urine. It perhaps often does
fo ; but how it fhould produce the lingular change
that takes place in the ftate of the urine, is not to be
eaiily explained. It certainly often happens, that cal-
culous matters are long prefect in the urinary paffages,
without having any fuch effect as that of producing
diabetes in any ihape.

Some have fuppofed that the difeafe occurs from a
relaxed ftate of the fecretory vefTels of the kidneys ;
and -indeed the diflections of perfons who had died of
this difeafe have ihown the kidneys in a very flaccid
{late. This, however, is probably to beconfidered as
rather the effect than the caufe of the difeafe*

That no topical affection of the kidneys has a (bare
in producing this difeafe, and thnt a fault in the an%
m ulation of the fluids is rather to be blamed, I con-
clude from hence, that even the folid food taken in,
increafes the quantity of the urine voided, at the fame
time with an increafe of the faccharine matter above-
mentioned.

MDXI.

The diabetes has been fuppofed to be owing to a
certain ftate of the bile ; and it is true, that this difeafe
has fometimes occurred in perfons who were at the
• fame time affected with difeafes of the liver : but this
occurrence does not ofren take place ; and the diabe-
tes frequently occurs feparately from any affection of
the liver. In twenty inflances of diabetes which I
have fcen? there was not in any one of them any evi-
dent affection of the liver.

Tie

.246 PRACTICE

The explanation that has been offered of the nature
and operation of the bile, in producing diabetes, is ve-
ry hypothetical, and nowife Satisfying.

MDXII.

As I have already faid, I think it probable, that in
moft cafes the proximate caufe of this difeafe is fome
fault in the aflimilatory powers, or in thofe employed
in converting alimentary matters into the proper ani-
mal fluids. This I formerly hinted to Dr. Dobfon,
and it has been profecuted and publifhed by him ;
but I mufl own that it is a theory embarraffed with
fome difficulties which I cannot at prefcnt very wjsll
remove.

MDXIIL.

The proximate caufe of diabetes being fo little
known or afcertained, I cannot propofe any rational
method of cure in the difeafe*. From the teftimony
tif fever a) authors, I believe that the difeafe has been
cured: but I believe alfo? that this has feldom happen-
ed ; and when the difeafe has been cured, I doubt
much if it was effected -by the feveral remedies to
which thefe cures have been afcribed. In all the in-
ftances of this difeafe which I myfelf havefeen, and in

feveral

* The difeafe is happily not very common ; but, when a phyfici^
an is called, he is under the neceffity of doing fomething, and not
remaining inactive. Some general directions may therefore be ac-
ceptable to the young pra&itioncr.

The cure will principally confiil in avoiding whatever may relax
the renal veffels, efpecially by avoiding ilrong drink. As the quan-
tity of urine is always lefs in proportion as the perfpiration is in-
creafed, it feems adviiable to keep the furface of the fkin lax and
perfpirable ; and, if the patient's ftrength allows him, he ought fre-
quently to ufe bodily exercife to promote fvveat. For afimilar r'ea
fon, external cold muft be avoided, becaufe by diminiming perfpira-
tion, a targer quantity of fluids is derived to the kidneys.

la fome cafes, the difeafe may be probably owing to a lax or
weak ftatc of the kidneys : hence the indication of tonics, as Peru-
vian bark, and other tonic bitters.

OF P II Y S I C. 247

feveral others of which I have been informed, no cure
of it has ever been made in Scotland, though many
inftances of it have occurred, arid in mofl of thfm the
remedies recommended by authors have been diligent-
ly employed. I cannot, therefore, with any advan-
tage, enter into a detail of thefe remedies ; and as the
difeafe, together with its feveral circumftances, when
they fhall hereafter occur, is likely to become the fub-
ject of diligent investigation, I avoid going farther at
prefent, and judge it prudent 'to fufpend my opinion
till I ihall have more observations and experiments up-
on which I can form it more clearly.

CHAP. XIII.

OF THE HYSTERIA, OR THE HYSTERIC
DISEASE.

MDXIV.

r | ^HE many and various fymptoms which have been
_§, fuppofed to belong to a difeafe under this appella-
tion, render it extremely difficult to give a general
character or definition of it. It is, however, proper
in all cafes to attempt fome general idea ; and there-
fore, by taking the mod common form, and that con-
currence of fymptoms by which it is principally dif-
tinguiihed, I have formed a character in my fyltern of
Methodical Nofology, and (hall here endeavour to il-
luilrate it by giving a more full hiftory of the pheno-
mena.

MDXV.

The difeafe attacks in pr.roxyf.ns or fits. Thefe
commonly begin by fome pain and fulnefs felt in. the

left

448 P R A C T I C £

left fide of the belly. From this a ball* feerns to move
with a grumbling noiie into the other parts of the bel-
ly ; and, making as it were various convolutions
there, feerns to move into the ftomach ; and more
distinctly ftill rifes up to the top of the gullet, where
it remains for fome time and by its p re flu re upon the
larynx gives a fenfe of fuffocation. By the time that
the difeafe has proceeded thus far, the patient is af-
fe&ed with a flupor and infer niibility, while at the fame
time the body is agitated with various convulficns.
The trunk of the body is wreathed to and fro, and
the limbs are varioufly agitated ; commonly the con-
vulfive motion of one arm and hand, is that of beating
writh the clofed fift, upon the brealt very violently
and repeatedly. This ftate continues for fome time,
and has during that time fome remiffions and renew-
als of the convuliive motions ; but they at length
ceafe, leavKg the patient in a ftupid and feemingly
ileeping ftate. More or lefs fuddenly, and frequently
with repeated fighing and fobbing, together with a
murmuring noife in the belly, the patient returns to
the exercife of fenfe and motion, but generally with-
out any recollection of the feveral circumllances that
had taken place during the fit.

MDXVI.

This is the form of what is called an byjleric parox-
yfm, and is the mod common form ; but its p-.irox-
yfms are confiderably varied in different perfons, and
even in the fame perfon.at different times. It differs,
by having more or fewer of the circumflances above-
mentioned : by thefe circumftances being more or
lefs violent ; and by the different duration of the
•whole fit.

Before the fit there is fomctimes a fudden and unu-
fually large flow of limpid mine. At the coming on

of

* Commonly called Glubus hyfiericus by authors.

OF P PI Y S I C. 249

of the fit, the ftomach is fometimes affected with vo-
miting, the lungs with coniiderable difficulty of breath-
ing, and the heart with palpitations. During the fit,
the whole of the belly, and particularly the navel, is
drawn flrongly inwards ; the iphincter and ani is fome-
times fo firmly conducted as not to admit a fmall
glyiter-pipe, and there is at the fume time an entire
fuppreffion of urine. Such fits are, from time to time,
ready to recur; and during the intervals, the patients
are liable to involuntary motions,, to fits of laughing
and crying, with fudden tranfition from the one to the
other ; while fometimes falie imaginations, and fume
degree of delirium, alfo occur.

MDXVIL

Thefe affections have been fuppofed peculiar to the
female iex ; and indeed they moil commonly appear
in females : but they fometirnes, though rarely, at-
tack the male fex ; never, however, that I have ob-
ferved, in the fame exquiiite degree.

In the female fex5 the difeafe occurs efpeciallv
from the age of puberty to that of thirty-five years ;
and though it does- fometimes, yet very feldom ap-
pears before the former or after the latter of thefe pe-
riods.

At all ages, the time at which it rrfoft readily occurs
is that of the menftrual period.

The difeafe more efpecialiy affects the females of
the moil cxquifitely fanguine and plethoric habits^
and frequently affects thofe of the moll robufl and maf-
culine conftitutions.

It affects the barren more than breeding \vcmen,
and therefore frequently young widows.

It occurs efpecialiy in thofe female^ who are liable
to the Nympbomania ; and the Nofologifls have pro-
perly enough marked one of the varieties of this dif-
eafe by the title of Hyfieria Libidinofa.

In the perfons liable to the fits of this difeafe, it is

VOL, II. I i readily

PRACTICE

readily excited by the paffions of the mind, and by
every conliderable emotion, efpecially thofe brought
on by furprife.

. The perfons liable to this difeafe acquire often fuch
a degree of fenfibility, as to be ftrongly affected by
every hnpreffion that comes upon them by furprife.
MDXVII1.

In this hiftory, there appears to be a concurrence
of fymptoms and circumitances properly marking a
very particular difeafe, which I think may be diftin-
guiihed frorri all others. It feems to me to have been
improperly confidered by phyficians as the fame with
fome other difeafes, and particularly with hypochon^-
driafis. The two difeafes may have fome fymptoms
in common, but for the moil part are confiderably dif-
ferent.

Spafmodic affections occur in both difeafes; but
neither fo frequently nor to fo great a degree, in hy-
pochondriafis as in hyfteria.

Perfons liable to hyfteria are fometimes affected at
the fame time with dyfpepfia. They are often, how*
ever, entirely free from it ; but I believe this never
happens to perfons affected with hypochondriafis.

Thefe different circumftances mark fome difference
in the two difeafes ; but they are ftill more certainly
diftinguiihed by the temperament* they attack, and by
the time§ of life at which they appear to be moil ex-
quifitely formed.

It has been generally fuppofed, that the two difeaf-
es differ only in refpeft of their appearing in different
fexes. But this is not well founded : for although the
hyfteria appears moil commonly in females, the male

* Hyfteria attacks the fanguineand plethoric, but Hypochondri-
afis the melancholic.

§ Hypochondriafis fcarcely ever appears early In life, nor HyfteJ
ria late ; and Hypochondriacs becomes aggravated, but H-yttena ;o
lieved by advancing age.

Q F PHYSIC. 251

fex is not absolutely free from it, as I have obfervcd
above ; and although the hypochondriafis may be
moil frequent in men, the inilaaces of it in t{ie female
fex are very common*.

From all thefe confederations, it mutt I think, ap*
pear, that the hyfterja may be very well, and properly.,
difiinguifhed from hypochondriacs.

Further, it feems to me to have been with great im-
propriety, that almpfl every degree of the irregular
motions of the nervous fyflem has been referred to the
one or the other of thefe two difeafes. Both are
marked by a peculiarity of temperament, as well as
by certain fytnptoms commonly accompanying that ;
buii fome ot thefe, and many others ufually marked by
the name of nervous fymptoms, may, from various
caufes, arife in temperaments different from that which
is peculiar to either hyiieria or hypochondriafis, and
without being joined with the peculiar fymptoms of
either the one or the other difeafe : fo that the appel-
lations pf Hyfteric and Hypochondriac are very inac-
curately applied to them. Under what view thefe
fymptoms are otherwife to be conliderecl, I am not.
ready to determine ; but muft remark, that the appel-
lation of Nervous Difeafes is too vague and undetine4
to be 9f any ufeful application.

MDXX.

Having thus endeavoured to diftinguifti hyiieria
from every other difcafc, I fliali now attempt its pecu-
liar pathology. With refpecl to this, I think it will,
in the firfl place, be obvious, that irs paroxyfms.be-
gin by sf convulfive and fpafoodic affection of the ali-
mentary canal, which is afterwards communicated to
the brain, and to a great part of the nervous fyflem.

I i 2 Although

The Hypochondriafis in women has frequently been miilaken
for Hyfteria.

P R A G T I C E

Although the difeafe appears to begin in the alimen-
tary canal, yet the connexion which the paroxyfms fo
often have with the menftrual flux, and with the dif-
eafes that depend on the ftate of the genitals, fhows,
that the phyficians have at all times judged rightly in
coniklerirsg this difeafe as an affection of the uterus
and other parts of the genital fyftem.
MDXXL

With regard to this, however, I can go no farther.
In what manner the uterus, and particularly the ova-
ria, are affected in this difeafe ; how the affection of
thefe is communicated, with particular circumftances,
to the alimentary canal ; or how the affection of this,
riling up \varcls, affects the brain, fo as to occafion
the particular cc-nvulfions which occur in this difeafe,
I cannot pretend to explain.

But although I cannot trace this difeafe to its fvjft
caufes, or explain the whole of the phenomena, I
hope, that with refpect to the general nature of the dif-
eafe, I may form fome general conclufions, winch may
itTve to direct our conduct in the cure of it.
MDXXII.

Thus, from a confideration of the predifponent and
occasional caufes, it \viil, I think, appear, that the
chief parf of the proximate caufe is a mobility of the
fyilem, depending generally upon its plethoric ftate,
MDXXI1I.

Whether this difeafe ever arifes from a mobility of
the fyftem, independent of any plethoric ftate of it, I
cannot pofitjvely determine ; but in many cafes that
have fubiiltcd for fome time, it is evident that aftn-
iibilirv, and confequentiy a rnobili-y, are acquired/
which often appear when neither a general plethora
can be fuppofed to fubfift, nor an occaiional turgef-
cence to have happened. However, as we have
fhown above, that a difteniion of the vefTels of the
brain feems to occaiion epilepfy, and that a turgef-

cence

OF PHYSIC, 253

cence of the blood in t!\e vefTds of the lungs feerns to
produce afthma ; fo analogy leads me to fuppofe, that
a turgefcence of blood in the uterus, or in other parts
of the genital iyftesn, may occafion the fpafmodic and
convfcliive morions "which a v> ;>•-:: ar in hyfteria. It will,
at the fame I'Hie, be evident, that this affection of the
genitals muil especially occur in plethoric habits ; and
every circumftance mentioned in the hiftory of the
difeafe ferves to confirm this opinion with rcfpscl to
its proximate cauie.

MDXXIV.

From this view of the fubjecl, the analogy of hyf-
teria and epiiepfy will readily appear ; and why,
therefore, I am to fay that the indications of cure lire
the fame in both.

As the indications, fo the feveral means of anf.vcr-
ing them are fo much the fame in both difeaks, that
the fame obfervarions and directions, with regard to
the choice and employment of thefe remedies, that
have been delivered above on the ftibjecr of epi-
iepfy, will apply pretty exactly to hyfteria; and there-
fore need not to be repeated here*. C H A P.

* Although the indications of cure maybe the fame in borh dif-
<eafe.c, yet in hyfleria we arc more frequently under the needier of
relieving the violence of the fymptoms than in rpilepfy : ;HK! for
this puvpole we rauft have recoiirfo to n v.uiely of z*ntifj

A fa foci Ida, in various forms, is uiually employed; : •
volatile fpirits: bin; both thefe joined, prove more el
either of them finely. There are. excellent formulae of tin'-; kin<
the London and Edinburgh pharmacopoeias, under the title of Soi-
ritus Amor.nie foetidns. It's dofe is twenty or thirty drops, re-
peated, according to the urgency of the ca^e, feverul times a-day.

The 'i indura CrtOorei comp'.ifita of the Edinburgh l^liannaco-
poeia is another excellent formula of the fame kind ; it is a remcdv
of real efficacy. The dcfe of it is thirty or forty chops repeated
occafionally.

The Tfn&ura Valcrianae volitilis of both tlie pharmacopoeias is1
alfo fiequently ufcd. It's dofe i^ a lea-fpoonful or two.

Few of the coinpofitions of the (hops are found to be more effi-
cacious aritifpafmodics than the Spiritus ^Etheris Vitriolicus com-
pofitus of the London Pharmacopeia., it's cicfe is from thirty to

254 PRACTICE

C H A P. XIV.

OF CANINE MADNESS AND HYDROPHOBIA.

.MDXXV.

TIIS difeafe has been ib exactly and fully defcrib-
ed ID books that are in every body's hands, that
it is on no account necefTiry to pve any hiftory of it
here ; and \vith refpedl to the pathology of it, I find
that I can fay nothing Satisfying to nryfelf, or that I
can expect to prove fo to others. I find alfo, with re-
fpedt to the cure of this difcafe, that there is no fnb-
jecl in which the fallacy of experience appears more
ftrongly than in this. From the mod ancient to the
prefent times, many remedies for preventing and cur-

fifty drops in two or three fpoonfulls of cold water ; and it rnuft be
f wallowed immediately on pouring out of the vial.

Thefe and other ar.tifpafmodics mny be ufed promlfcuoufly ; for,
in different cafes and conilitutions, they prove differently efficacious.
Sometimes they may be varioufly combined with one another, and
with opium. Opium, however, ought not to be ufed, except where
other antifpafmodics fail, as it always 'eaves the patient lemarkably
low, and liable to returns of the paroxyfms.

Beiides theufe of thefe remedies internally, fome of them may be
ufefully employed externally ; as ftvong volatile fpirits to the nofe,
the vitriolic aether to the temples, &c.

Tliefe remedies are chiefly defigned for occafionally removing the
violence of the fymptoms ; but the fetid gums, in fub.'lance, mud
be uftd, when we wiili to procure permanent effects . The formu-
lae of them are in both our Pharmacopoeias, under the title of gum-
pills ; but they will be found much more efficacious by adding to
them a little caftor, as in the following formula :
R,. Pilul. Gummof. Edinb. gfs.
Callor Ruflic, 5i.
Syr. 'fimpl. q. 1".
M. f. maif. in pilulas Ixxv, equales dividend.

Five of thefe pills may be taken twice a-day wafhing them co\vn
\vith a tea-cupful of cold water with a tea-fpoonful of volatile tinc-
ture of Valeria;; in it.

The Pilula? fcetidce of the Sweedifii Pharmacopoeia, in which caf-
tor is one of the ingredients, is preferable to either &f qwr gum-pills.

O F P H Y S I C. 255

ing this difeafe have been recommended under the
fanction of pretended experience, and have perhaps
alfo kept their credit for forae time: but fucceeding
times have generally, upon the fame ground of expe-
rience, deftroyed that credit entirely ; and mod of the
remedies formerly employed are now fallen into abfo-
lute neglect. In the prefent age, foinc new remedies
have been propofed, and have experience alledged to
vouch for their efficacy ; but many doubts (till remain
with refpect to this : and though I cannot determine
in this matter from my own experience, I think it in-
cumbent on me to give the beft judgment; I can form
with refpeft to the choice of the remedies at prefenj:
recommended.

MDXXVF.

I am, in the firft place, firmly perfuaded, that the
mod certain means of preventing the conferences
of the bite, is to cut out, or otherwife deilroy, the part
in which the bile has been made. In this every body
agrees ; but with this difference, that fome are of opi-
nion that it can only be effectual when it is done very
foon after the wound has been made, and they there-
fore neglecl it when this opportunity is miffed. There
have been, however, no experiments made proper to
determine this matter : and there are many confidera-
tions which lead me to think, that the poifon is not
immediately communicated to the fyftern ; and there-
fore, that this meafure of deftroymg the part may be
pra&ifed with advantage, even many days after the
bite has> been given.

MDXXVIL

Whilit the dale of our experience, with refped: to
feveral remedies now in ufe, is uncertain, I cannot
venture to affert that any of thefe is abfolutely inef-
fectual ; but I can give it as my opinion, that the effi-
cacy of mercury, given very largely, and perfiited in
for a long time, both as a means of prevent ing the

diieafe,,

256 PRACTICE

difeafe, and of curing it when it has aftually come on,
is better fupported by experience than that of any
other remedy now propofed or commonly employed.

BOOK IV.

O F

V E S A N I JE,-

OR OF THE

DISORDERS OF THE INTELLECTUAL
FUNCTIONS.

CHAP. I.
OF V E S A N I JE IN GENERAL.

MDXXVIII.

THE Nofologifls, Sauvages and Sagar, in a clafs of
difeafes under the title of VFSANIJE, have com-
prehended the two orders, of Hallucinationcs or Falfe
Perceptions, and of Morojitates or Erroneous Appe-
tites and Paflions ; and, .in like manner, Linnaeus in
his clafs of MENTALES, correfponding to the Vefaniae
of Sauvages, has comprehended the two orders of Ima-
ginarii and Patbetici, nearly the fame with the Hallu-
cinationes and Morojitates of that author. This, how-
ever, from ieveral confederations, appears to me im-
proper ; and I have therefore formed a clafs of Vefa-
niae nearly the fame with the Paranoias of Vogel, ex-
cluding

O F P H Y S I C. 257

eluding from it the Hallucinationes and Morofitates,
which I have referred to the Morbi Locales. Mr.
Vogel has done the like, in feparating from the Para-
noias the falfc perceptions and erroneous appetites ;
and has thrown thefe into another clafs, to which he
has given the title of Hyperaefiefes.
MDXXIX.

It is indeed true, that certain hallucinationes and
rnorofitiites are frequently combined with what I
propofe to coniider as flriclly a vefania or an errone-
ous judgment ; and fometimes the hallucinationes
feem to lay the foundation of, and to form almoft en-
tirely, the vefania. But as mod part of the halluci-
nationes enumerated by the Nofologifls are affections
purely topical, and induce no other error of judgment
belide that which relates to the fmgle object of the
fenfe or particular organ affected ; fo thefe are certain-
ly to be feparated from the difeaies which confift in a
more general affection of the judgment. Evert when
the hallucinationes conilantly accompany or feem to
induce the vefania, yet being fuch as arife from inter-
nal caufes, and may be prefumed to arife from the
fame caufe as the more general affection of the judg-
ment, they are therefore to be confidered as fymptoms
of this only.

In like manner I judge with refpect to the moron*-
tates, or erroneous paffions, that accompany vefania ;
which, as confequences of a falfe judgment^ mullbe
considered as arifing from the fame caufes, and as
fymptoms only, of the more general affection.

There is, indeed, one cafe of a morofuas which
feems to induce a vefania, or more general affection of
the judgment ; and this may lead us to coniider the
vefania, in this cafe, as a fymptom of an erroneous
appetite, but will not afford any good reafon for com-
prehending the morofitates in general under the vefa-
ice, confidered as primary difeafes.

VOL, II. K k The

-5$ F R A C T I C E

The re, of the chfs of Vtfanire

to t' V lajulty, ieems from eveiy
[o

ilar clilV be cofrifcenehds-d under

this ' '<';ing as' they af-

iecl or fteeping. Thcfe

again bs eoqfidered, as

in an erroneous judgment, to which I (hall

: :ji of Delirium ; or as they confiit in

a \Yi. lion bf judgment, which I fhali

;i \vith the cohiideratiofl of DC-

v

/i s men cliifer greatly in the foundnefs and force cf
their judgment , io it n proper here to aicertain

more pr what e ror or imperfection of our judg-

:is morbi-.l, and to ad-
-irium and fatuity. In

;;, 1 ihall firii: coniider the morbid errors of
judgment under tr. -iation of Delirium,

has been co cd to denote every

mode of fucb eh

As our i "it :" chicfiv exerc::ed in difcerning

and ju^ the fever al relations of things, 1 ap--

pre! :tt delirium may be defined to be, — In a

p-rfcn asvake, a falfe or rnifhken judgment of thufe
relations of things, which as occurring moil frequent-
ly in life, are thofe about which the generality cf
men form the feme judgment ; and particularly when
the judgment is very diilcTer;t from what the peribn
himieif had before ufually formed.
MDXXXII.

With this miftaken judgment of relations there is
frequently joined fome falfe perception of external ob-
jects, without any evident fault in the organs of fcnfe,
and which ieems therefore to depend upan the imagi-
nation

.OFF H.Y S I C. 259

nation, aiiiing from a c i in th ' b 'ain ;

or an erronc
as the diYeafj.

M • II.

Another circuimfla ,
urn, is a very uir

refpcci to mod of r.he atlairs or corn
laid 'up in the memory are, in rn [
the fame manner-; fo a v
individual, mull p v

i.'ioii foi adatiori of :

therefore this in;- iy Iiu

n of ideas, . - coi

I

IVIDXXXIV.

A third'circum'.' d liriu

tion or p.idion, I ;
the timid kind
tion or ju ,-. : :it5 it is p"op

ther in / to the peril n

himfelf, icr i

other men.

i> ,!;*(„ ., < :

f

Ou,—

ons of i , •• ai.,n, ai.d

CDnimon'v ions,

Sucii dthriuin is of ; as it is c

vr, us it is en-
.. ^ tirely

26o PRACTICE

tirely without any fuch combination. It is the latter
cafe that we name Infanity ; and it is this kind of de-
lirium onlv that I am to treat of here.

MDXXXVI.

Infanity may perhaps be properly confidered as a
genus comprehending many different fpecies, each of
which may deferve our attention; but before proceedr
ing to the confideration of particular fpecies, I think
it proper to attempt an inveftigation of the caufe of
infanity in general.

MDXXXVII.

In doing this, I mall take it for granted, as demon-
flrated elfcwhere, that although this difeafe feems to
be chiefly, and fometimes folely, an affection of the
mind ; yet the connection between the mind and bo-
dy in this cafe is fuch, that thefe affections of the mind
mud be confidered as depending upon a certain ftate
of our corporeal part. See Halleri Prim. Lin. Phy-
lio. log. § DLXX. See Boerhaavii Inft. Med.
S DLXXXI. pcxcvi.

MDXXXVIII.

Admitting this propoiition, I mud in the next place
afTurne another, which I like wife fuppofe to be demon-
ftrated cife where. This is, that the part of our body
•more immediately connected with the mind, and
therefore more efpeciarlly concerned in every affection
of the intellectual functions, is the common organ of
the nerves ; which I fhnll, in what follows, fpeak of
under the appellation of the Brain.
MDXXXIX.

Here, however, in arTummg this Lift proportion, a
very great difficulty immediately prefents itfelf. Al-
though we cannot doubt that the operations of our in-
tellect always depend upon certain motions taking
place in the brain, (fee Gaub. Path. Med. § 523;)
vet thefe motions have never been the objects of our
fenfes, nor have we been able to perceive that any par-
ticular

OF PHYSIC.

ticular part of the brain has more concern in the ope*
rations of our intellect than any other. Neither have
we attained any knowledge of what fhare the feveral
parts of the brain have in that operation ; and there-
fore, in this iicuation of our fcience, it mud be a very
difficult matter to difcover thole ftatcs of the brain
that may give occaiion to the various (late of. our intcl-
Jedual functions.

MDXL.

It may be obferved, that the different date of the
motion of the blood in. the veflels of the brain has
fome fhare in affecting the operations of the intellect :
andphyncians, in feeking for the caufes of the differ-
ent (tares of our intellectual functions, have hardly
looked further than into the (late of the blood, or into
the condition of the blood itfelf : but it is evident that
the operations of the intellectual functions ordinarily
go on, and are often considerably varied, without our
being able to perceive any difference either in the mo-
tions or in the condition of the blood.

MDXLI.

Upon the other hand, it is very probable that the
ftate of the intellectual functions depends chiefly upon
the Itate and condition of what is termed the Nervous
Power, or, as we fuppofe, of a fubtile very moveable
fluid, included or inherent, in a manner we do not
clearly underftand, in -every part of the medullary fub-
(lance of the brain and nerves, and which in a living
and healthy man is capable of being' moved from eve-
ry one part to every other of the nervous fvftem.

iMDXLH.

With refpcct to this power, we have pretty clear
proof that it frequently has a motion from the fentient
extremities of the nerves towards the brain, and there-
by produces fenfarion ; and we have the fame proof,
that in confequence of volition the nervous power has
a motion from the brain into the mufcles or organs

of

•262 PRACTICE

of motion. Accordingly, as fenfation excites our in-
tellectual operations, and volition is the effect of
"-_', lui-.l as the connection between fenfation and
volition is always by the intervention of the brain and
c/ intellectual operations; fo we can hardly doubtv
thr.t thefe iarr.er depend upon certain motions, and
the various modification of ihefs motions, in the
brain.

JXLIII.

To afcertam tlie ci'lcrcnt; itates of thefe motions
may be very diillcuit ; and pbyficians h;;vc commonly
confider^d it to be fo very nfipvfterious, that they have
g-.:HL'ra-iy despaired of attaining any knowledge v
regard to it ; but I confider fuch ahiblute defpair, and
the negligence it iflfpires, to be always very blamea-
ble ; and I fhall now venture to go fbme length in the
inquiry, hoping that forne fteps made with tolerable
iirmnefa e ucs to go It ill further.

MDXLIV.

To this purpofc, I think it evident, that the nervous
power, in the whole as well as in the nervous fyflem,
and particularly in the brain, is at different times in
different degrees of mobility and force. To thefe dif-
ferent flatcs, 1 beg leave to apply the terms ^Excite-
ment wdColIapfe. To that date in which the mobili-
ty and force are fufficientfor the exercifc of the func-
tions, or when thefe Hates are any way preternatural-1
]y increafed, I give the name (A Excitement j and to
that llatein whuih the mobility and force are not fuf-
ficient iur the ordinary exercifc of the functions, » r
when they are diminiihed from the (late in which they
had been before, I give the narne of Collapfe. 1 beg,
however, it may be obfervid, tnat by tliefe terms I
mean to exprefs marter- only ; and wiiLoiit in-

tending, by thcf.: rerms, lo expLiin the clrcurnf:::'
or condition inical, of the nc: r or flu-

id in thci'j dirTerent Uate:.

MDXLV.

OF PHYSIC. 263

MDXLV.

That thefe different: ftates of excitement ana colhpfe
take place on different occaiions, mull, I think, be
rnaniieil from numbcrlefs phenomena of the animal
cecohomy : but it is especially to our prefent purpofe
to obfcrve, that the different ftates of excitement and
collapfe, are in no inftance more remarkable, than in
the different dates of waking and ileeping. In the
latter, when quite complete, the motion and mobili-
ty of the nervous power, with refpeclc to the whole of
what are called the Animal Functions, eiiiir.ly ceafe,
or, as I would exprefs it, are in a (late of cciL:pu;; and
are very different from the itata of waking, which in
healthy perfons I would call a Hate of general and
entire excitement.

MDXLVI.

This difference in thefLu. .:•; >f the nervous power in
fleeping and waking being admitted, I muffc in the
next place obferve, that when thefe dates are changed
from the one into the other, as cornnipnly happens
every day, the change is hardly ever made inftantane-
oufiy, but almoft always by degrees, and in forne
length of time only : and this may be obferved with
refpecl to both fenfe and motion. Thus when a per-
fcn is falling afleep, the feniibility is gradually dimi-
niihcd : fo that, although fome degree of fleep has
come on, flight impreflions will excite fenfation, and
bring back excitement; v/hich tie fame, or even
flronger impreilinns, will* be insufficient to product
when the Tcate of fieep has continued U^n^er, and i?,
ns \ve may lay, more complete. In like manner, the
power of voluntary motion is gradually diminished.
Jn fome members it fails fooner than in others ; and it is
iome time before it becomes general and confiderablc
over the whcle.

The fame gradual prog re fs may be remarked in a
perfon's coming out of fieep : The ears in this caft are

oh en

264 ?' R A C T I G E

often awake before the cy£s are opened or fee clearly,
and the fenfes are often awake before the power of
voluntary motion is recovered ; and it is curious to
cbferve, that, in fome cafes, fenfations may be excited
without producing the ordinary ailociation of ideas.
See Mem, de Berlin. 1752.

MDXLVII.

From all this, I think it will clearly appear, that not
only the different flares of excitement and collapfe can
take place in different degrees, but that they can
take place in different parts of the brain, or at leaft^
with refpectto the different functions, in different de-
grees.

As I prefume that almoft every perfon has perceived
the gradual approach of ileeping and waking, i like-
"Vvife fuppofe every perfon has obferved, that, in fuch
intermediate date of unequal excitement, there almoft
always occurs more or lefs of delirium, or dreaming,
if any body choofes to call it fo. There are in this
flate falfe perceptions, falfe afibciations, falfe judg-
ments, and difproportionate emotions ; in morn, alt
the circuiriiiances by which I have above defined deli-
rium.

This clearly mows chat delirium may depend, and
I mail hereafter endeavour to prove that it commonly
does depend upon fome inequality in the excitemenc
of the brain ; and that both thefe aiTertions are found-
ed on this, that, in order to the proper exercifc
of our intellectual functions, the excitement muft be
complete, and equal in every part of the brain. For
though we cannot fay that the vefliges of ideas are
laid up in different parts of the brain, or that they are
in fome meafure diffufed over the whole, it will follow
upon either fuppofuion, that as our re:ifoning our in-
tellectual operatior;, always require the orderly and ex-
ad recollection or memory of aflbciatcd ideas ; fo, if
any part of the brain is not excited, or not excitable,

that:

O F P H Y S I C. 265

that recollection c:nnct properly take place, while at
the lame time other parts of the brain, more excited
and excitable, may give falie perceptions, aiibciaticns,
and judgments.

MDXLVIII.

It will ferve to illufirate this, that the collapfe in
fleep is more or lefs complete ; or that the fleep, as
we commonly fpeak, is more or lefs profound ; and
therefore, that in many cafes, though fleep takes place
to a considerable degree, yet certain impreffions do
fail take effect, and excire motions, or, if you will,
fenfations in the brain ; but which fenfations, upon
account of the collapfed fcare of fo great a part of the
brain, are generally of the delirious kind, or dreams,
confirming of falfe perceptions, aiTociations, and judg-
ments, that would have been corrected if the brain had
been entirely excited.

Every one, I believe.) has obfervcd, that the moft
imperfect fleeps, are thofe chiefly attended with dream-
ing ; that dreams, therefore, moffc Commonly occur
towards morning, when the complete Hate of fleep is
paiimg away ; and further, that dreams are mod com-
monly excited by ilrong and uneafy imprcffions made
upon the body.

1 apprehend it may alfo be, an illuflration of the
-fame thing, that, even in waking hours, we have an
inflance of an unequal (late of excitement in the brain
producing delirium, Such, 1 think, occurs in the
cafe of fever, In this it is maniferl, that the energy
of the brain, or its excitement, is considerably dirni-
niliied with refpecl to the animal functions : and it is
accordingly upon this ground that I have explained
above, in XLV. the delirium which fo commonly at-
tends fever. To what 1 have there fa id tl fhall here
only add, that it may ferve to confirm my doctrine,
that the delirium in fever corhes on at a certain period
of the difeafe only, and that we can commonly dSfc'Irii

VOL. II. L 1

266 PRACTICE

its approach by a more than ufual degree of it appear-
ing in the time of the patient's falling into or coming
out of ileep. It appears, therefore, that delirium,
when it full conies on in fever, depends upon an ine-
quality of excitement ; and it can hardly be doubted,
that the delirium which comes at length to prevail in
the entirely weakened ftate of fevers, depends upon
the fame caufe prevailing in a more confiderable de-
gree.

MDXLIX.

From what has been now delivered, I hope it will
be iuiticicntly evident, that delirium may be, and fre*
quently is, occafioned by an inequality in the excite-
ment of the brain.

How the different portions of the brain may at the
fame time be excited or collapled in different degrees,
or how the energy of the brain may be in different de-
grees offeree, with refpe&tothe ieveral animal, vital,
and natural functions, I cannot pretend to explain ;
but it is fufficiently evident in fact, that the brain
may be at one and the fame time in different conditi-
ons with refpect to thefe functions. Thus in inflam-
matory difeafes, when by a flimulus applied to the
brain the force of the vital functions is preternaturally
increafed, that of the animal is either little changed,
or coniiderable diminiihed. On the contrary, in ma-
ny cafes of mania, the force of the animal functions
depending always on the brain, is prodigicuily increaf-
ed, while the fcate of the vital function in the heart is.
very little or not at all changed. I muft therefore fay
again, that how difficult foever it may be to explain
the mechanical or phyfical condition of the brain
in fuch cafes, the facts are fufficient to ihow that there
is fuch antinequality as may diiturb our intellectual
operations.

MDL.

I have thus endeavoured to explain the general

caufe

O F P H Y S I C. 267

caufe of Delirium; which is of two kinds : according
as it is with, or without, pyrexia. Or the fird I take
no further notice here, havjng explained it as well as
I could above in XLV.

I proceed now to confider that delirium which pro-
perly belongs to the clafs of Vefaniss, and which I
ihall treat of under the general title of Infant ty.

MDLI.

In entering upon this fubjed, it immediately occurs,
that in many inllances of infinity, we find, upon dif-
fedlion after death, that peculiar ciroumfiances had
taken place in the general condition of the brain. In
many cafes, it has been found of a drier, harder, and
firmer confidence, than what it is ufually of in per-
ions who had not been affected with that difenfe. In
ether cafes, it has been found in a more humid, foft,
and flaccid fiate ; and in the obfervations of the
late Mr. Meckel*, it has been found conlklerably
changed in its denfity or fpecific gravity. Whether
thefe different ftates have been obferved to be uni-
formly the fame over the whole of the brain, I cannot
certainly learn ; and I fufpect the cii (lectors have nor
always accurately inquired into this ci re u in fiance :
but in feverai inilances, it appears that thefe dates had
been different in different parts of the brain ; and in-
flances of this inequality will afford a confirmation of
our general doctrine.

The accurate Morgagni has obferved, that in mani-
acal perfons the medullary portion of the brain is un-
ullully dry, hard, and firm : And this he had fo fre-
quently obferved, that he was difpofed to confider ic
as generally the cafe. But in moil of the particular
inflances which he has given, it appears, that, for the
moll part, while the cerebrum was of an uiiufually
hard and firm confidence, the cerebellum was of its

LI 2 llfuitl

n pourmMce ly/}-. f appeare n many

inftanccs of infane perfons, that the rr.edulktry fubltancc of the cere-
brum was drier, and of a iefi' fpecific gravity, t!iau in perfons who
hxd been always ofa fourx!j«og?r.ent,

2*63 PRACTICE

iifual foftnefs : and in many of the cafes it was unfa-
ally foft and flaccid. In fome other cafes, Morgagni
obferves, that while a part of the .cerebrum was hard-
er and firmer than ordin%ry, other parrs of it were
:. rurally foft.

MDLII.

Thefe obArrvations tend to confirm our general doc^
trine : and there are others which I think will apply

pofe,

the ' tlon of the bodies of perfons who
had -'.1 under infanity, various organic affe&ions

had been dil .' in p-.i;ticular parts of the brain ;

and it is :'u .c: itiy n-.'j,.:-u.>ie, that ftich organic ak
feclions niiyjit lu^e produced a different degree of
excite nen r free and affected parts, and rnuil

j<J in loLiie meafure the free communi-
cai:- ~een the fever al parts of the brain, and in

e occaiioned uifanityi

There have -,cciUTed lo many iniiances of this
that I believe phyficians are gcneraiiy difpofed to u,!-
fpe.^1: Or'^anic lefions of the brain to exiu ir^almpft
every cafe ofiijfanity.

MDLI1I.

This, however, is probably a miftak^ : f >r we know]
that there have bo ;ices of ; m ivhicrl

the perfons have entirely recovered; and it is
to fuppofe that any organic lefions of the brain h;
fuch calc taken place. Such traniitory caics, iiu
render it probable, that a tlate of excitcmcn:5 ch,.

; by various caufes, hcid been the caufe of fuch in*
ilauceb of hilarity.

MDLIV.

It is indeed fur}. -"ted, that, in many in lances

of iniV; -''.u had b tied i-iVr

death, tg that, ai Ic leii-oiis haq

before (ubillled in th'c bm; :t miy -

bid ftateof.the brain ;. . .. •

mai

OF PHYSIC. 269

mav ferve to fliow, that organic lefions had not been,
the'caufe of the difeafe ; but it does not allure us that
no morbid change had taken place in the brain : for it
is probable, that the directors were not always aware
of its being the general condition of hardnefs and den-
iity, as different in different parts of the brain, true
\vas to be attended to, in order to difcover the catife of
the preceding difeafe ; and therefore many of them
had not with this view examined the (late of the brain,
as Morgagni feems carefully to have done.

: MDLV.

Having thus endeavoured to inveiTIgate the caufe
of infinity in general, it were to be wiihed that I could
apply the doclrine to the the fever al

fpccies of it, according as they : n the differ-

cnt (late and circumftances of In, and thereby

to the e (tab ii fhing of a fcicntific and accurately7 adapted
ineihod of eyre. Thefe purpofes, however, appear to
me to be extremely difficult to be attained ; and I can-
not hope to execute them here. All I can do is to
make fame attempts, and offer fome inflections which
further obfervation and greater fagucky, may hereaf-
ter render more ufeful.

MDLVI.

The ingenious Dr. Arnold has been cor- bly

employed in diftinguifhing the dltferc f iri-

\ianity as they appear with relpec: to the mind ; and
his labours may hereafter prove ufeful, when we fhall
come ro know ibmething more of the difFerent (lutes of
the brain correfponding to thefe different fiates of the
mind; but at. prefcnt 1 can make little application of
his numerous diilincllons It r.ppc:irs to me that he
has chiefly pointed out and enumerated diilinctions,
t.;:at are merely varieties, which can lead to little or
no variety of practice : and I arn efpecially led to form

s the Litter concluiion, becaufe thefe varieties appear to
me to be often coinbiruxd togeth^r^and to be often

changed

370 PRACTICE

changed into one another, in the fame perfon ; in
whom we muft therefore fuppofe a general caufe of
the difeafe, which, fo far as it can be known, miifl
etlabliih the pathology, and cfpecially direcl the prac-
tice.

MDLVIL

In my limited views of the different ftates of infani-
ty, I rnuil go on to confider them under the two heads
of Mania and Melancholia: and though I am fenfible
th;;t thefe two genera do not comprehend the whole
of the fpecies of infinity, I am not clear in affigning
the other fpecies which may not be comprehended
under thcfc titles. I lhall, however, endeavour, on
r-roper occnfions, as I go along, to point them out as
well as I can.

C II A P. II.
OF -MANIA, OR MADNESS.

MDLVI1I.

'HE circumftsrnces which I have mentioned above
in MDXXXV. as conflituting delirium in general,
GO more efpeci:iily belong to that kind of it which I
lhall treat of here under the title of MANIA.

There is fometimes a faife perception or imagination
of things prcfent that are not ; but this is not a con-
fiant, nor even a frequent., attendant of the difeafe.
The falfe judgment, is of relations long before laid up
in the memory. It very often turns upon one fmgle
fubjecl ; but more commonly the mind rambles from
one fubjecl: to another with an equally falfe judgment

con-

O F P H T S I C. 271

concerning the mod part of them ; and as at the fame
time there is commonly a falfe affociation, this increaf-
es theconfuilon of ideas, and therefore the falfe judg-
ments. What for the moil part more efpecially dif-
unguimes the difeafe is a hurry of mind, in purfuing
any thing like a train of thought, and in running from
one train of thought to another. Maniacal perfons
are in general very irafcible; but what more particu-
larly produces their angry emotions is, that their
falfe judgments lead to fome action which is al ways
pufhed with impettiofity and violence ; when this is
interrupted or reftrained, they break out into violent
anger and furious violence againft every perfon near
them, and upon every thing that (lands in the way of
their impetuous will. The falfe judgment often turns
upon a miflaken opinion of fome injury fuppofed to
have been formerly received, or now fuppofed to be
intended : and it is remarkable, that fuch an opinion
is often with refpeft to their former dearetl friends and
relations ; and therefore their refentmcnt and anger
are particularly directed towards thefe. And although
this ihould not be the cafe, they commonly foon lofe
that refpecl and regard which they formerly had for
their friends and relations. With all thefe circum-
flances, it will be readily perceived, that the difeafe
mud be attended very conftantly with that incoherent
and abfurd fpeech \ve call raving. Further, with the
circumftances mentioned, there is commonly joined an
unufual force in all the voluntary motions ; and an
infenfibility or refinance of the force of all impreffi-
ons5 and particularly a relillance of the powers of ilecp,
or cold,, and even of hunger ; though indeed in ma-
ny inftances a voracious appetite takes place.

MDL1X.

It appears to me that the whole of thefe circum-
ftances and fymptorns point out a considerable and un-
ufual excefs in the excitement of the brain, efpecially

with

272 PRACTICE

with refpeft to the animal functions ; and it appears
at the fame time to be manifefiiy in Tome meafure un-
equal, as it very often takes place with refpecl tothefe
'functions alone, while at the fame time the vital and
natural are commonly very little changed from their
ordinary healthy fiate.

MDLX.

How this excels o? exciien.^nt is produced, it may
be difficult to ex-plain. In tl :;ces of

what Salivates has named t :;cilca, and

in all the infLinccs I have mention-id in my Nofo!
under the title of the Mania Corpprea^ it may be fuppof--
ed that a morbid organic affection is produced in lorae
part of the brain ; and how that may produce sn in-
created or unequal excitement in certain parts of it, I
have endeavoured to explain above in MDLII. But I
mufr at the fame time acknowledge, that fuch remote,
caufcs of mania have very rarely occurred ; and that
'therefore fome other caufes of the difeafe mull be
fought for.

The effects of violent emotions or paffions of the
mind have more frequently occtired as the remote
caufes of mania ; and it is iiifficiently probable, that
fuch violent emotions, as they do often immediately
produce a temporary increafe of excitement, fo they
may, upon ic.rns cccaficns of their permanent inhe-
rence or frequent repetition, produce a more cor.ii-
derable and more permanent excitement, that is, a
mania.

"With refpecl to thofe caufes of mania which arife in
confequence of a melancholia which had previoufty
long lubfiiled ; \vhether we confrler that melancholia
as a partial i; or us n loi;;.r perilling attachment to

one train of thinking, it will be readily perceived, that
in either cafe fuch an increafe of excitement may take
place in fo confiderable a degree, and in fb la; ere a

, i lion

O F P H Y S I C. 273

portion of the brain, as may give occafion to a complete
mania.

MDLXI.

Thefe confiderations with regard to the remote
caufes appear to me to confirm fufficiently our general
doctrine of increafed and unequal excitement in the
mania which I have defc^ibed above ; but I mud own
that I have not exhaufted the fubjecr, and that there
are cafes of mania of which 1 cannot affign the remote
caufes : but although I cannot in all cafes explain in
what manner the mania is produced, I prefume, from
the explanation given, and efpecially from the fymp-
toms enumerated above, to conclude, that the dif-
eafe defcribed above depends upon an increafed ex-
citement of the brain ; an opinion in which I am the
more confirmed, as I think it will point out the proper
method of cure. At leail I think it will mofl clearly
explain the operation of thofe remedies, which, fo far
as I can learn from my own experience and that of
others, have proved the mofl fuccefsful in this difeafe ;
and, to iliuftrate this, I now enter upon the confidera-
tion of thefe remedies, and to make feme remarks upon
the proper manner of employing them.
MDLXII.

Reftraining the anger and violence of rfladmen is
always neceffary for preventing their hurting them-
felves or others : but this reftraint is alib to be confi-
dercd as a remedy. Angry paflions are always ren-
dered more violent by the indulgence of the impetu-
ous motions they produce ; and even in madmen the
feeling of reftraint will fometimes prevent the efforts
which their paffion would otherwife occafion. Re-
ftraint, therefore, is ufeful, and ought to be complete ;.
but it fliould be executed in the eafieft manner pofli-
ble for the patient, and the (trait waiftcoat anfwers eve-
ry purpofe better than any other that has yet bet-n.
thought of. The reftraining madmen by the force of

VOL. II. M m other

274 PRACTICE

other men, as occafioning a conftant flruggle and vio-
lent agitation, is often hurtful. Although, on many
occalions, it may not be fafe to allow maniacs to be
upon their legs or to walk about, it is- never definable
to confine them to a horizontal fituation ; and whene-
ver it can be admitted, they Should be more or lefs in
an erect pofture. Although there may be no fymp-
toins of any preternatural fulnefs or increafed impetus-
of blood in the veffels of the brain, a horizontal pof-
ture always increafes the fulnefs and terfion of thefe
veifcls, and may thereby increafe the excitement of
the brain.

MDLXIII.

The reftraint mentioned requires confinement with-
in doors, and it ihould be in a place which prefents as
few objects of fight and hearing as pcffible ; and par-
ticularly, it mould be removed from the objects that
the patient was formerly acquainted with, as thefe
would more readily call up ideas and their various aflb-
ciations. it is for this reafon that the confinement of
madmen fhould hardly ever be in their ufual habita-
tion; or if they are, that their apartment fhould be
flripped of all its former furniture. It is alfo for the
mofl part proper, that maniacs ihould be without the
company of any of their former acquaintance ; the ap-
pearance of whom commonly excites emotions that
increafe the difeafe. Strangers may at fait be often-
five ; but in a little time they come to be objects either
of indifference or of fear, and they fhould not be fre-
quently changed.

MDLXIV,

Fear being a pafTion that diminishes excitement,
may therefore be oppofed to the excefs of it ; and
particularly to the angry and irafcible excitement of
maniacs. Thefe being more fufceptible of fear than
might be expected, it appears to me to have been
commonly ufeful. In moft cafes it has appeared to

be

OF PHYSIC. 275

be neceflary to employ a very conflant impreffion of
fear; and therefore to infpire them \virh the awe and
dread of fome particular perfons, efpecially of thofe
who are to be conftamly near them. This awe and
dread is therefore, by one means or other, to be ac-
quired ; in the firft place, by their being the authors
of all the reftraints that may be occasionally proper ;
but foinedmes it may be neceflary to acquire it even
by fhipes and blows. The former, although having
the appearance of more feverity, are much fafer than
ftrokes or blows about the head, Neither of them,
however, mould be employed further than ftems ve-
ry neceflary, and mould be truitcd only to thofe whofe
difcretion can be depended upon. There is one cafe
in which they are fuperfluous ; that is, when the ma-
niacal rage is either not fufceptible of fear, or incapa-
ble of remembering the objects of it; for 'in inch in-
ilances, ftripes and blows would be wanton barbarity.
In many cafes of a moderate difeafe, it is of advantage
that the perfons who are the authors of reflraint and
punifhment fhould be upon other occafions the be-
flowers of indulgence and gratification that is admif-
fible ; never, however, neglecting to employ their
"awe when their indulgence ihali have led to any
abufe.

MDLXV.

Although in mania, no particular irritation nor ful-
nefs of»the fyftem feem to be preterit, it is plain, that
the avoiding all irritation and means of fulnefsis pro-
per ; arid therefore, that a diet neither ftimuiating
nor nourifhing is commonly to be employed. As it
may even be ufeful to diminiih the fulnefs <<f the fyf-
tem fo both a low and a fparc diet is likely in moll ca^
ies to be of fervice.

MDT.XVI.

Upon the fame principle, although no unufual ful-
ncis of rue body be preient, it may be of advantage

M in z 'to

276 PRACTICE

to diminifh even its ordinary fulnefs by different eva-
cuations.

Blood-letting, in particular, might be fuppofed ufe-
ful ; and in all recent cafes of mania it has been com-
rnonly praclifed, and I think with advantage ; but
•when the difeafe has fubiifted for fome time, I have
feldom found blood-letting of fervice. In thofe in-
Itances in which there is any frequency or fulnefs of
pulfe, or any marks of an increafed impetus of the
blood in the veiTels of the head, blood- letting is a pro-
per and even a ncceirary remedy. Some practitioners,
in fuch cafes, have preferred to a particular manner of
blood-letting, recommending arteriotomy, fcarifying
the hind-head, or opening the jugular vein ; and
where any fulnefs or inflammatory difpofir.ion in the
yeffels of the brain is to be fufpecled, the opening of
the veiTels nearer! to them is likely to be of the great-
cit fervice. The opening, however, of either the
temporal artery or the jugular vein in maniacal per-
fons is very often inconvenient ; and it may generally
be fufficient to open a vein in the arm, while the body
is kept in fomewhat of an eredl pofture, and fuch a
quantity of blood drawn as nearly brings on a deliqui-
um anirni, which is always a pretty certain mark of
Ibme diminution of the fulnefs and tenlion of the vei-
fels of the brain.

MDLXVII.

For the fame purpofe of taking off the fulnefs and
teniion of thefe veilels of the brain, purging may be
employed ; and I can* in no other view underftand
the celebrated ufc of hellebore among the ancients. I
cannot, however, fuppcfe any fpecitic power in helle-
bore ; and can by no means find that, at leaft the
black hellebore, is fo efficacious with us as it is faid to
have been at Anticyra. As coflivenefk, however, is
commonly a very conftanc and hurtful attendant of
mania, purgatives come to be fometirnes very nccef-

fary;

O 1< PHYSIC. 277

fary ; and I haye known fome benefit obtained from
the frequent ufe of pretty draflic purgatives. In this,
however, I have been frequently difappointed ; and I
have found more advantage from the frequent ufe of
cooling purgatives, particularly foluble tartar, than
from more draftic medicines.

MDLXVIII.

Vomiting has alfo been frequently employed in ma-
nia; and by determining powerfully to the furface of
the body, it may poffibly diminish the fulnefs and
tenfion of the velfels, and thereby the excitement of
the brain ; but I have never carried the ufe of this re-
medy fo far as might enable me to judge properly of
its eifecls. Whether it may do harm by impelling
the blood too forcibly into the veliels of the brain,
'or whether by its general agitation of the whole fyf-
tem it may remove that inequality cf excitement
which prevails in mania, I have not had experience
enough to determine.

MDLXIX.

Frequent (having of the head has been found offer-
vice in mania, and by promoting perfpiration it pro-
bably takes off from the excitement of internal parts.
This, however, it is likely, may be more effectually
done by bliftering, which more certainly takes off the
excitement of fubjaccnt parts. In recent cafes it has
been found ufeful by inducing fleep ; and when it has
that effect, the repetition of it may be proper : but in
maniacal cafes that have laded for fome time, blifter-
ing has not appeared to me to be of any fervice ; and
in fuch cafes alfo I have not found perpetual bliflers,
or any other form of ifllie, prove ufeful.
MDLXX.

As heat is the principal means of firft exciting the
nervous fyfiein, and eitablifhing the nervous power
and vital principle in animals ; fo, in cafe of preterna-
tural exckement, the application cf cold might be

iuppoJtd

273 PRACTICE

fuppofed a proper remedy : but there are many inftan-
ces of maniacs who have been expofed for a great
length of time to a confiderable degree of cold with-
out having their fymptoms any wife relieved. This
may render in general the application of cold a doubt-
ful remedy ; but it is at the fame time certain, that
maniacs have often been relieved, and fomethnes en-
tirely cured, by the ufe of cold bathing, efpecially
when adrniniftered in a certain manner. This feems
to confift, in throwing the madman in the cold wa-
ter by furprife ; by detaining him in it for fome length
of time; and pouring water frequently upon the head,
while the whole of the body except the head is im-
inerfed in the water ; and thus managing the whole
procefs, ib as that, with the affiitance of fome fear, a
refrigerant efFecl: may be produced. This, I can af-
firm, has been often ufeful ; and that the external ap-
plication of cold may be of fervice, we know further
from the benefit which has been received in fome ma-
niacal cafes from the application of ice and fnow to
the naked head, and from the application of the not-
td Clay Clap.

Warm bathing alfo has been recommended by
fome practical writers ; and in forne rigid melancholic
habits it may poliibly be ufefuJ, or as employed in
the manner prefcribed by fome, of immerling the low-
er parts of the body in warm water, while cold water
aired upon the head and upper parts. Of this
practice, however, I have had no experience, and in
the common manner of employing warm bathing I
have found it rather hurtful to maniacs.

MDLXXI.

rcording to my fuppofition that the difeafe de~
•3 upon an inereaied excitement of the brain, e-
•allv with refped to the animal functions, opium,
io commonly powerful in inducing deep, or a confi-
derable colhpie as to thefe functions, fhouJd be a

powerful

OF PHYSIC, 279

powerful remedy of mania. That it has truly proved
fuch, I believe from the tedimony of Bernard Huet,
whofe practice is narrated at the end of Wepferi Hif-
toria Apopleclicorum. I leave to my readers to ftudy
this in the work I have referred to, where every part
of the practice is fully, and it appears to me, very ju-
dicioufly delivered. I have never indeed carried the
trial ib far as feems to be requtiite to an entire cure :
but I have frequently employed in fome maniacal caf-
es large dofes of opium ; and when they had the effect:
of inducing fleep, it was maniferlly with advantage.
At the fame time, in fome cafes, from doubts, whe-
ther the difeafe might not depend upon fome organic
leiions of the brain, when the dpiurn would be fuper-
fluoos ; and mother cafes, from doubts, whether there
might not be fome inflammatory affection joined with
the mania, when the opium would be hurtful, I have
never puihed this remedy to the extent that might be
neceffary to make an entire cure.
MDLXXII.

Camphi) e has been recommended as a remedy of
mania, and there are inftances alledged of its having
performed an entire cure. As it appears from the ex-
periments of Beccaria that this fubilance js polfeiTed
of a fedative and narcotic virtue, thefe cures are not
altogether improbable: butinfeveral trials, and even
in large dofes, I have found no benefit from it ; and
excepting thofe in the PhilofophicalTranfacHons, N°.
400. I have hardly met with any other teilimonies in
its favour.

MDLXXTIL '

I have been informed that fome maniacs have been
cured by being compelled to conftant and even hard
labour ; and as a forced attention to the conduct of
any bodily exercife is a vrry certain means of divert-
ing the mind from purfuing any train of thought, it is

highly

28o PRACTICE

highly probable that fuch exercife may be ufeful in
many cafes of mania.

I muft conclude this fubjecl with obferving, that e-
ven in feveral cafes of complete mania I have known
a cure take place in the courfe of a journey carried on
for fome length of time.

MDLXXIV.

Thefe are the remedies which have been chiefly
employed in the mania that has been above defcrib-
ed5 and I believe they have been employed promifcu-
ouQy without fuppoling that the mania \vas to be dif-
tinguifhecl into different fpecies. Indeed I am not
ready to fay bow far it is to be fo diftinguifhed, but I
ihall offer one observation which may poiiibly merit
attention.

It appears to me that there are two different cafes of
mania that are efpecially different according to the ori-
ginal temperament of the pCrfons whom the difcafe
affects. It perhaps occurs mod frequently in perfons
of a melancholic or atrabilarian temperament ; but it
certainly does alfo often occur in perfons of that very
opposite temperament which phylicians have named
the Sanguine. According as the difeafe happens to
occur in perfons of the one or other of thefe tempera-
ments I apprehend it maybe coniidered as of a differ-
ent nature ; and I believe, that accurate obfervation,
employed upon a fufficient number of cafes, would dif-
cern fome pretty conftant difference, either of the
fymptoms, or at lead of the ftate of fymptoms, in the
two cafes. I imagine that falfe imaginations, particu-
lar averfions and refentments, are more fixed and Hea-
dy in the melancholic than in the fanguine ; and that
fomewhat inflammatory is more commonly joined
\vith mania in the fanguine than in the melancholic.
If fuch difference, however, does truly take place, ic
\vill be obvious, that it may be proper to make fome
difference alfo in the practice. I am opinion, that in

the

OF PHYSIC. 281

the mania of fanguine perfons, blood-letting and other
antiphlogiftic meafures are more proper, and have been
more ufeful, than in the melancholic. I likewife ap-
prehend that cold bathing is more ufeful in the fan-
guine than in the melancholic : but I have not had ex-
perience enough to afcertain thefe points with fuffici-
ent confidence.

I have only to add this other obfervation, that ma-
niacs of the fanguine temperament recover more fre-
quently and more entirely than thofe of the melancho-
lic.

CHAP. III.

OF MELANCHOLY AND OTHER FORMS
OF INSANITY.

MDLXXV.

MELANCHOLY has been commonly confidered
as a partial infanity ; and as fuch it is defined
in my Nofology : but I now entertain doubts if this be
altogether proper. By a partial infanity, I undcrftartd
a falfe and miftaken judgment upon one particular fub-
je&, and what relates to it ; whilft, on every other
fubjecl, the perfon affeded judges as the generality of
other men do. Such cafes have certainly occurred ;
but, I believe, few in which the partial infanity is flricl-
ly limited. In many cafes of general infanity, there
is one fabjecT: of anger or fear, upon which the falfe
judgment more particularly turns, or which is at lead
more frequently than any other the prevailing objecl:
of delirium : and though, from the inconfiftency which
this principal objecl: of delirium muft produce, there
VOL. II. N n is

232 PRACTICE

is therefore alfo a great deal of infinity with regard
to mod other objects ; yet this iaft is in very diiTc
degrees, both in different perfons, and in the fame per-
fon at different limes. Thus perfons coufidered as ge-
nerally ihfane, will, however, at times, and in ionic
cafes, pretty conftantly judge properly enough of prc-
lent cifcumftances and incidental occurrences; though,
•when thefe objects engaging attention are not pre-
fented, the operations of imagination may readily
bring back a general confufion, or rccal the; particular ,
object of the delirium. From thefe considerations, I
am inclined to conclude, that the limits between ge-
neral and partial infanity cannot always be fo exactly
aifigned, as to determine when the partial affection is
to be confidered as giving a peculiar fpecies of difeafe,
different from a more general infanity.

MDLXXVI.

When infanity, neither ftrictly partial, nor entirely
nor conftantly general, occurs in perfons of a fanguirie
temperament, and is attended with agreeable, rather
than with angry or gloomy emotions, I think fuch a
difeafe muft be conlidered as different from the Ma-
nia defcribed above : and alfo, though partial, mufl
be held as different from the proper Melancholia to
be mentioned hereafter.

MDLXXV1I.

Such a difeafe, as different from thofe defcribed M-
DLIV. requires, in my opinion, a different adminiftra-
tion of remedies ; and it will be proper for me to take
particular notice of this here.

Although it may be neceffary to reft rain fuch infane
perfons as we have mentioned MDLXXVJ. from purfu*.
ing the objects of their falfe imagination or judgment,
it will hardly be requilite to employ the fame force
of reitraint that is neceifary in the impetuous and an-
gry mania. It will be generally fufficient to acquire
ibme awe over them* that may be employed, and

iome times

O F P H Y S I'C. 283

fometimes even be neceffary, to check the rambling
of their imagination, and incoherency of judgment.
MDLXXV1II.

The reftraint juft now mentioned as neceffary will
generally require the patient's being confined to one
place, for the fake of excluding the objects, and more
particularly the perfons, that might excite ideas con-
nefted with the chief objects of their delirium. At
the fame time, however, if it can be perceived there
are objeds or perfons that can call off their attention
from the purfuit of 'their own difordered imagination,
and fix it a little upon fome others, thefe laft may be
frequently presented to them : and for this reafon, a
journey, both by its having the effect of interrupting
all train of thought, and by prefenting objects engag-
ing attention, may often be ufefuL In fuch cafes al-
fo, when the inianity, though more efpecially fixed
upon one mi (taken f abject, is not confined to this
alone, but is further apt to ramble over other fubjects,
with incoherent ideas, I apprehend the confining or
forcing fuch perfons to fome conftant uniform labour^
may prove an uieful remedv.

MDLXXIX.

When fuch cafes as in MDLVI. occur in fanguine
temperaments, and may therefore approach more
nearly to Phrenitic Delirium ; fo, in proportion as the
fymptoms of this tendency are more evident and con~
iiderable, blood-letting and purging will be the more
proper and necelTary.

MDLXXX.

To this fpecies of infanity, when occurring in fan-
guine temperaments, whether it be more or lefs parti-
al, I apprehend that cold bathing is particularly a-
dapted; while, in the partial infanity of melancholic
perfons, as I fhall mow hereafter, it is hardly admiffi-
ble.

Q 2 MBLXXXI.

284 PRACTICE

MDLXX^XL

Having thus treated of a ipecies of infanity, differ-
ent, in my apprehenfion, from both the Mania and
Melancholia, I proceed to confider what feems more
properly to belong to this laft.

MDLXXXII.

The difeafe which I name Melancholia is very oft-
en a partial infanity only. But as in many inftances,
though the falfe imagination of judgment feems to be
with refpect to one iubject only ; yet it feldom happens
that this does not produce much inconfiftency in the
other intellectual operations : And as, between a ve-
ry general and a very partial infanity, there are all the
poflible intermediate degrees ; fo it will be often diffi-
cult, or perhaps improper, to diftinguifh melancholia
by the character of Partial Infanity alone. If I mil-
take not, it mull be chiefly diftinguifhed by its occur-
ring in perfons of a melancholic temperament, and by
its being always attended with foine feemingly ground-
lefs, but very anxious, fear.

MDLXXXIIL

To explain the caufe of this, I mud obferve, that
perfons of a melancholic temperament are for the mo ft
part of a ferious thoughtful difpofition, and difpofed
TO fear and caution, rather than to hope and temerity.
Perfons of this cad are lefs inoveable than others by
any impreffions ; and are therefore capable of a clofer
or more continued attention to one particular object,
or train of thinking. They are even ready to be en-
gaged in a conftant application to one f abject ; and
are remarkably tenacious of whatever emotions they
happen to be affected with.

MDLXXXIV.

Thefe circumftances of the melancholic character,
feem clearly to mew, that perfons ftrongly affected
with it may be readily feized with an anxious fear ;
and that this, when much indulged, us is natural to

fuch

OF PHYSIC. 285

fuch perfons, may eafily grow into a partial infanity.

MDLXXXV.

Fear and d ejection of mind, or a timid and defpond-
ing difpolition, may arife in certain Rates, or upon cer-
tain occafions of mere debility : and it is upon this
footing, that I fuppofe itfometimes to attend dyfpep-
lia. But in thefe cafes, I believe the defpondent dif-
pofition hardly ever arifes to a confiderable degree, or
proves fo obftinately fixed as when it occurs in per-
ilous of a melancholic temperament. In thefe lail, al-
though the fear proceeds from the fame dyfpeptic
feelings as in the other cafe, yet it will be obvious,
that the emotion may arife to a more confiderable de-
gree ; that it may be more anxious, more fixed, and
morq attentive ; and therefore may exhibit ail the va-
rious circurnitances which I have mentioned in ?/rcc-
xxii. to take place in the difeafe named KYPOCITON-

DRIAS1S.

MDLXXXVI.

In considering this fubjecl formerly in diftinguifliing
Dyfpepfia from Hypochondriacs, although the fymp-
coms affecting the body be very much the fame in
both, and even thofe affecting the mind be force what
iimilar, I found no difficulty in diftinguiihirtg the lat-
ter difeafe, merely from its occurring in perfonj of a
melancholic temperament, But I nluil no w acknow-
ledge, that I am at a lots how to determine in all caf-
es hypochondriacs and melancholia may be ciiftin-
guiilied from one another, whilft the fam era-

meat is common to both.

MDLXXXVII.

I apprehend, however, that the diftindtton may be
generally afcertained in the following manner.

The hypochondriafis I v/ould confider being al-
ways attended with dyfpeptic fymptoms : and tlioi^h
there may be, at the fame time, an anxious melancho-
lic fear arifing from the feeling of thefe fymptoms;

286 PRACTICE

yet while this fear is only a miftaken judgment with
refpecT: to the ftate of the perfon's own health, and to
the danger to be from thence apprehended, I would
ilill confiderthe difeafe as hypochondriacs, and as dif-
tinct from the proper melancholia. But when an anx-
ious fear and defpondency arifes from miftaken judg-
ment with refpecl: to other circumftances than thofe of
health, and more efpecially when the perfon is at the
fame time without any dyfpeptic fymptoms, every
one will readily allow this to be a difeafe widely dif-
ferent from both dyfpepiia and hypochondriafis ; and
it is, what I would ftridly name Melancholia.
MDLXXXV1IL

In this there feems little difficulty ; but as an exqui-
iltely melancholic temperament may induce a torpor
Jind' flownefs in the action of the fiomach, io it gene-
rally produces fome dyfpeptic fymptoms ; and from
thence there may be fome difficulty in diftinguifhing
fuch a cafe from hypochondriacs. But I would main*
tain, however, that when the characters of the tem-
perament nreftrongly marked ; and more particularly
\vhen the falie imagination turns upon other fubjects
than that of health, or when, though relative to the
performs own body, it is of a groundlefs and abfurd
kind ; then, notwithstanding the appearance of fome
dyfpeptic fymptoms, the cafe is flili to be confide red
KS that of a melancholia, rather than a hypochondri-
afis.

MDLXXXIX.

The difeafe of melancholia, therefore manifeflly
depends upon the general tt rnperament of the body :
and although, in many peribns, this temperament is
not attended with any morbid afFeftion either of mind
or body ; yet when it becomes exquiiitdy formed,
and is in a high degree, it may become a difeafe affect-
ing both, and particularly the mind. It will therefore
be proper to confider in what this melancholic tcmpc-

rament

OF PHYSIC. 287

rament efpecially confifts ; and to this purpofe, it may
be obferved, that in it there is a degree of torpor in
the motion of the nervous power, both with refpect to
feniation and volition ; that there is a general rigidity
of the iimple folids ; and that the balance of the fan*
guiferous fyflem, is upon the lide of the veins. BuC
ftll thefe circumftances are the directly oppoiiteof thofe
of the fangujpe temperament ; and muft therefore alfo
produce an oppofite ftate of mind.

MDXC.

It is this ftate of the mind, and the (late of the brain
correfponding to it, that is the chief object of our pre-
fent confideration. But what that Hate of the brain
is, will be fuppofed to be difficult to explain $ and it
may perhaps ieem ram in me to attempt it.

1 will, however, venture to fay, that it is probable
the melancholic temperament of mind depends upon
a drier and firmer texture in the medullary fubflance
of the brain ; and that this perhaps proceeds from a
certain want of fluid in that fubftance, which appears
from its being of a lefler fpecific gravity than ufual.
That this itate of the brain in melancholia does actu-
ally cxift, I conclude, firjt, from the general rigidity
of the whole habit ; and, fecondly, from difledlions,
fhowing fuch a flate of the brain to have taken plar.e
in mania, which is often no other than a higher degree
of melancholia: It does not appear to me anywifs
difficult to fuppofe, that the fume ftate of the brain
may in a moderate degree give melancholia ; and in
a higher, that mania which melancholia fo often pafTes
into ; efpecially if I (hall be allowed further vo fuppofe,
that either a greater degree of nrmneis m die fubftance
of the brain may render it iufceptible of a higher de-
gree of excitement, or that one portion of the brain
may be liable to acquire a greater firmnefs than others,
and confequently give occafion to that inequality of
excitement upon which mania fo much depends.

MDXCI

PRACTICE

MDXCI.

I have thus endeavoured to deliver what appears t®
me moft probable with reipect to the proximate caufe
of melancholia; and although the matter faould in
fome refpe&s remain doubtful, I am well perfuaded
that thefe obfervations may often be employed to di-
rect our practice in this diicafe, as I fhall now endea-
vour to mow.

MDXCIL

In moil of the inftances of melancholia, the mind
is to be managed very much in the fame manner as I
have advifed above with regard to hypochondriacs ;
but as in the cafe of proper melancholia, there is com-
monly a falfe imagination or judgment appearing as a
partial infanity, it may be further ncceffary in fuch
cafes to employ fome artifices for correcting fuch ima-
gination or judgment.

MDXCIII.

The various remedies for relieving the dyfpeptic
fymptoms which always attend hypochondriacs, will
feldom be either requifite or proper in melancholia.

There is only one of the dyfpeptic fymptoms, which,
though there mould, be no other, is very conitantly
prelent in melancholia, and that is coftivenefs. This
it is always proper and even neceifary to remove ; and
I believe it is upon this account that the ufe of purga-
tives has been found fo often ufeful in melancholia.
Whether there be any purgatives peculiarly proper in
this cafe, I dare not pofitively determine ; but with
refpecl to the choice of purgatives in melancholia, I
am of the fame opinion that I delivered above on this
famefubjecl: with refpecl to mania.
MDXCIV.

With refpecl to other remedies, I judge that blood-
letting will more feldom be proper in melancholia than
in mania ; but how far it may be any in cafe proper,

mufl

O F P H Y S I G. 289

muft be determined by the fame consideration as in
the cafe of mania.

MDXCV.

The cold bathing that I judged to be fo very ufe-
ful in fcveral cafes of infanity, is, I believe, in melan^
cholia, hardly ever fit to be admitted ; at leaft while
this is purely a partial affection, and without any
marks of violent excitement. On the contrary, upon
account of the general rigidity prevailing in melan-
cholia, it is probable that warm bathing may be often
ufeful.

MDXCVL

With refpecl: to opiates which I have fuppofed
might often be ufeful in cafes of mania, I believe
they can feldom be properly employed in the partial
infanities of the melancholic, except in certain inftanc-*
es of violent excitement, when the melancholia ap-
proaches nearly to the ftate of mania.
MDKCVil.

In fuch cafes of melancholia approaching to a flat®
of mania, a low diet may fometimes be neceffary ; but
as the employing a low diet almoft unavoidably leads
to the ufe of vegetable food, and as this in every tor-
pid ftate of the flomach is ready to produce fome dyf-
peptic fymptoms, fuch vegetable food ought, in mo-
derate cafes of melancholia, to be ufed with fome
Caution.

Though exercife, as a tonic power, is not proper
either in hypochondriafis or melancholia ; yet, with
refpecl: to its effcds upon the mind, it may be extreme-
ly ufeful in both, and in melancholia is to be employ-
ed in the fame manner that I have advifed above in the
cafe of hypochondriafis.

MDXCVIII.

Having now delivered my doctrine with refpecl to
the forms of infanity, I mould in the next place pro-
ceed to coniider the other genera of Amentia and

VOL. II. O o Oneir

PRACTICE

Qneirodynia, which in the Nofology I have arranged
under the order of Vefaniae : but as I cannot pretend
to throw much light upon thefe fubjects, and as they
are feldom the objects of practice, I think it allowable
for me to pafs them over at prefent ; and the particu-
lar circumftances of this work in fome meafure require
that I (hould do fo.

PART. 111.
OF CACHEXIES.

MDXCIX.

UNDER this title I propofe to eftablim a clafs of
difeafes, which coniift in a depraved (late of the
whole, or of a considerable part, of the habit of the
body, without any primary pyrexia or neurofis com-
bined with that flate.

MDC.

The term Cachexy has been employed by Linnaeus
and Vogei, as it had been formerly by other authors,
for the name of a particular difeale ; but the difeafe
to which thefe authors have affixed it, comes more
properly under another appellation ; and the term of
Cachexy is more properly employed by Sauvages and
Sagar for the name of a ciafs. In this I have follow-
ed the laft- mentioned nofologifls, though I find it dif-
ficult to give fuch a character of the clafs as will clear-
ly apply to all thefpecies I have comprehended under
it. This difficulty would be ilill greater, if, in the
clafs I have eilablifhed under the title of Cachexies^ I
were to comprehend all the difeafes that thofe other
nofologiils have done ; but I am willing to be thought

deficient

OF PHYSIC. 291

deficient rather than very incorrect. Thofe difficul-
ties, however, which itill remain in methodical nofo-
logy,, miift not a (Feel: us much in a treutife of practice.
If I can here properly diftjngtrifh and defcribe the fe-
veral fpecies that truly and moft commonly exift, I
lhall be the lefs concerned about the accuracy of my
general claffification ; though at the fame time this,
1 think, is always to be attempted ; and I (hall purfue
ix a-s well as I can.

BOOK I.

OF EMACIATIONS.

MDCI.

EMACIATION, or a coniiderable diminution of
the bulk or plumpnefs of the whole body, is for
the molt part only a fymptom of difeafe5 and very fel-
dom to be confidered as a primary and idiopathic af-
fection. Upon this account, according to my gene-
ral plan, fuch a fymptom might perhaps have been
omitted in the Methodical Nofology: but both the
uncertainty of concluding it to be always fymptorna-
tic, and the confiflency of fyflem, made me introduce
into the Nofology, as others had done, an order under
the title of Marcores ; and this renders it requifite
now to takefome notice of fuch difeafes.

MDCI I.

Upon this occalion, therefore, i hope it may be
ufeful to inveftigate the feverai cauf-s of emaciation
in all the different cafes of difeafe in which it appears.
And this I attempt, as the furefl means of determining
how far it is primary, or a fymptomatic affection on-

O o 2 » \y ;

PRACTICE

ly ; and even in the latter view, the investigation may
be attended with fome advantage.
MDCIH.

The caufes of emaciation may, I apprehend, be refer-
red to two general heads ; that is, either to a general
deficiency or fluid in the veflels of the body, or to the
particular deficiency of the oil in the cellular tex-
ture of it*. Thefe caufes are frequently combined
together; but it will be proper, in the firil place, to
ccnfider them feparately.

MDC1V.

As a great part of the body of animals is made up
of veflels filled with fluids, the bulk of the whole mud
depend very much on the fi7,e of thefe veffels, and
the quantity of fluids prefent in them : and it will
therefore be. fufliciently obvious, that a deficiency of
the fluids in thefe veflels muft, according to its degree,
occafion a proportionate diminution of the bulk of
the whole body. This, however, will appear full
more clearly, from conlidering that in the living and
found body the veflels every where feein to be preter-
naturally diftended by the quantity of fluids prefent in
them ; but being at the fame time elaftic, and con--
ftantly endeavouring to contract themfelves, they mud
on the withdrawing of the didending force, or, in
other words, upon a diminution of the quantity of
fluids, be in proportion contracted and dirninifhed in,
their fize: And it may be further obferved, that as
each part of the vafcular fydern communicates with
every other part of it ; fo every degree of diminution
of the quantity of fluid, in any one part, mud in pro-
portion diminifh the bulk of the vafcular fydem, and
confequently of the whole body§.

MDCV.

* Might not a third caufe be added, viz. a deficiency of the fo-
lid parts.

p There may, however, be a partial without general emaciation^

O F P H Y S I C. 293

MDCV.

The diminution and deficiency of the fluids may be
occaiioned by different caufes; fuch as, full, by a due
quantity of aliments not being taken in ; or by the ali-
ment taken in not being of a fufficiently nutritious
quality. Of the want of a due quantity of aliment not
being taken into the body, there is an inftance in the
atrofbia laftantium Sauvagefii, fpecies 3. and many
other examples have occurred of emaciation from
\vant of food, occaiioned by poverty, and other acci-
dental caufes.

With refpe£t to the quality of food, I apprehend
it arifes from the want of nutritious matter in the food
employed, that perfons living very entirely on vegeta*
bles are feldoin of a plump and iucculent habit*.

MDCVI.

A fecond caufe of the deficiency of fluids may be,
the aliments taken in not being conveyed to the
blood-veflels. This may octur from a perfon's being
affected with a frequent vomiting ; which, rejecting
the food foon afcerjc had been taken in, mull prevent
the necefiary fupply of fluids to the blood- veffels§.

Another

as is the cafe in a pained lirnb ; but the partial diminution of bulk,
in the difeafed limb, is not owing to a lefiened quantity of die ge-
neial mafs of the circulating fluids, but to the languid circulation
in that part, the arteries not propelling the blood through it with
fiifficicnt vigour.

* As ihe author fays at the conclufion of his chapter, «' After
*' having confu'eved the various caiifcs of emaciations, I faould per-
" haps treat of their cure : but it will readily appear, that the
*' greater part of the cafes above-mentioned are purely fymptomatic,
*' and confequently th?t the cure of them mu!l be that of the pri-
" mary difeaies upon which tht:y depend. Of thofe cafes that can
" any wife be confidered as idiopathic, it will appear that they
" are to be cured, entirely by removing the lemote caufes;" It
may not be improper to treat of the cure as we proceed.

The fpecies of emaciation may be obvioudy cured by a rich and
nutritious diet.

? This fpecu'3 may be cured by preventing tlic \omi-/ng by an-

PRACTICE

Another caufe, frequently interrupting the conveyance
of the alimentary matter into the blood-veffels, is an
obllrueiion of the conglobate lymphatic glands of the
niefentery, through which the chyle mull neceflarily
pafs to the thoracic duel:. Many inftances of emacia-
tion, feemingly depending upon this caufe, have been
obferved by phyficians, in perfons of all ages, but efpe-
cially in the young. It has been remarked, that fuch
cafes have moil frequently occurred in fcrophulous
perfons, in whom the mefenteric glands are commonly
affected with tumour or obftru&ion, and in^ whom,
generally at the fame time, fcrophula appears exter-
nally. Hence the Tabes fcrophulofa Synop. Nofolog. vol.
ii. p. 266. : And under thtfe I have put as fynonimes
Tabes glandularis, fp. 10. ; Tabes mefenterica, fp. 9. ;
Scrophuia mefenterua^ fp. 4. ; Atrophia infant Hi s> fp.
13.; Atrophia rachitica, fp. 8 ; Tabes rachialgica, fp,
16. At the fame time, I have frequently found the
cafe occurring in perfons* who did not {how any exter-
nal appearance of fcrophula, but in whom the mefen-
teric obftrudtion was afterwards difcovered by difTec-
tion. Such alfo I fuppofe to have been the cafe in
the difeaie frequently mentioned by authors under the
title of the Atrophia infantum. This has received its
name from the time of life at which it generally ap-
pears; but I have met with inftances of it at fourteen
years of age afcertained by diiTeclion. In feveral fuch
cafes which I have feen, the patients were without
fcrophulous appearances at the time, or at any period
of their lives before*.

In

tifpafmodics, efpecially opium, and by the ufe of gentle laxatives
occafionally. A nutritious diet will alfo be necelFaiy in thefe ca-

r

ies.

.* Thefe cafes are generally incurable ; if, however, there be no
fufpicicm of fcrophula we may attempt a cure, by endeavouring to
remove the obdruCtion, either by invigorating the habit, or by a6i-
Open and pure air, with exercifc fuited to the

OF PHYSIC. 295

In the cafe of phthifical perfons, I fhall hereafter
mention another caufe of their emaciation ; but it is
probable that an obftrucuion of the mefenteric glands,
which fo frequently happens in fuch perfons, concurs
very powerfully in producing the emaciation that
takes place.

Although a fcrophulous taint may be the moft fre-
quent caufe of mefenteric obftructions, it is fufficiently
probable that other kinds of acrimony may produce
the fame, and the emaciation that follows.

It may perhaps befuppofed, that the interruption of
the chyle's pafling into the blood-veffels may be forne-
times owing to a fault of the abforbents on the inter-
nal furface of the interlines. This, however, cannot
be readily afcertained : but the interruption of the
chyle's paffing into the blood-veffels may certainly be
owing to a rupture of the thoracic duel ; which, when
it does not prove foon fatal, by occafioning a hydro-
thorax, mult in a fhort time produce a general ema-
ciation*.

MDCVII.

A third caufe of the deficiency of the fluids may be
a fault in the organs of digeftion, as not duly convert-
ing the aliment into a chyle fit to form in the blood-
veiTels a proper nutritious matter. It is not, however,
eafy to aicertain the cafes of emaciation which are to
be attributed to this caufe ; but I apprehend that the
emaciation which attends long fiibfifting cafes of dyf-
pepfia, or of hypochondriacs, is to be explained chief-
ly in this way. It is this which I have placed in the
Nofology under the title of the Atrophla debilium ;
and of which the Atropbia Nervofa, Sauv. fp. i. is a

proper

flrcngth of the patient, the ufe of chalybeate waters, have admirable
effe&s in thefc cafes.

Peruvian bark fo often ufed as a tonic, is improper in all cafes
of obftru£ted glands, as are alfo ailringents and ftyptics.
r This is an abfolutely incurable cafe.

296 PRACTICE

proper inftance, and therefore put there as a fynoniniej
But the other titles of Atrophia Lateralis, Sauv. fp,
15. and Atrophia fenilis, Sauv. fp 1 1. are not fo pro-
perly put there, as they muft be explained in a differ-
ent maimed

MDCVIII.

A fourth caufe of a deficiency of the fluids in the
body, may be exceffive evacuations made from it by
different outlets ; and Sauvagcs has properly enume-
rated the following fpecies, which we have put as fy-
nonimes under the title*of Atrophia inanitorum ; as,
Tablet Nutricum, fp. 4. Atrophia nutricum, fp. 5. Atro-
phia a leucorrhcea^ fp. 4. Atrophia ab alvifluxu, fp,
6/ Atrophia a ptyalifmo, fp. 7. and laflly, the Tabes a
fanguiflnxu ; which, it is to be obferved, may arife not
only from fpontaneous hemorrhagies or accidental
wounds, but alfo from blood-letting in too large a
quantity, and too frequently repeated.

Upon this fubjeft it feems proper to obferve, that
a meagre habit of body frequently depends upon a
full perfpiration being conflantly kept up, though at
the fame time a large quantity of nutritious aliment
is regularly taken in§..

MDCIX.

Befides this deficiency of fluids from evacuations by
which they are carried entirely out of the body, there
may be a deficiency of fluid and emaciation in a con-
fulerable part of the body, by the fluids being drawn
into one part, or collected into one cavity ; and of

this

* This fpccies of emacration may be fuccefsfully cured by the
means of thofe remedies mentionedjin the notes on the articles 1204,

1206,1210, 1212, I2I3> 1215, I2l6, I22U

§ In thefe cafes aftringeuts are the principal remedies on which
we muft depend ; and thole altringents mult be chofen which are a-
daptedto fupprefs the peculiar evacuation that occdfions the difeafc.

OF PHYSIC. 297

this we have an inftance in the ^abcs a hydrope**
Sauv. fp. 5.

MDCX.

In the Methodical Noiblogy, among the other fy*
nonimes of the Atrophia inanitorum^ I have fet down
the Tabes dorfatts •; but whether properly or not, I at:
prefent very much doubt. In the evacuation confi-
dered as the caufe of this tabes, as the quantity eva-
cuated is never fo great as to account for a general de-
ficiency of fluids in the body, we muft feek for ano-
ther explanation of it. And whether the effects of
the evacuation may be accounted for, either from the
quality of the fluid evacuated, or from the iingularly
enervating pleaiure attending the evacuation, or from
the evacuation's taking off the tenfion of parts, theten-
fion of which has a (ingular power in fupporting the
tenfion and vigour of the whole body, 1 cannot poli-
tively determine ; but I apprehend that upon one or
other of thefe fuppofitions the emaciation attending
the tabes dorfalis muft be accounted for ; and there-
fore, that it is to be conlidered as an inftance of the
Atrophla debillum^ rather than of the Atrophia inani*

MDCXI.

A fifth caufe of a deficiency of fluids and of emaci*
ations in the whole or in a particular part of the body,
may be the concretion of the finall veflels, either not
admitting of fluids, or of the fame proportion as be-
fore ; and this feems to me to be the cale in the Atro-
phla fenilis, Sauv. fp. 2. Or it may be a palfy of the
larger trunks of the arteries rendering them unfit to
propel blood into the fmaller veffels ; as is frequently

VOL. 11. P p the

* The emaciation from this caufe is merely fymptomatic, and
can only be cured by curing the primaryfdiieafe,

§ If a particular abominable practice be the caufV, it muft be a-
bandoned before the cure can be attempted,

I* R A G T I C E

the cafe of paralytic limbs, in which the arteries air
affecledas well as tfec mufcles. The Atrophia later a^
//.r, Sauv. fp. 15. ieems to be of this nature*.
MDCXIL

A fecond general head of the caufes of emaciation I
have mentioned in MDCII. to be a deficiency of oil.
The extent and quantity of the cellular texture in
every part of the body, and therefore how confidera-
ble patt it makes in the bulk of the whole, is now well
known. But this fubftance, in different circumftan-
cesj is more or Ids filled with an oily matter ; and
therefore the bulk of it, and in a great meafure that of
the whole body, mud be greater or lefs according as
this fub Trance is more or lefs filled in that manner.
The deficiency of the fluids, for a reafon to be imme-
diately explained, is generally accompanied with a
deficiency of oil : but phylicia-ns have commonly at-
tended more to the latter cauie of emaciation than to
the other, that being ufually the molt evident ; and I
fhall now endeavour to affign the fe venal caufes of
the deficiency of oil as it occurs upon different occa-
fions,

MDCXIIL

The bufmefs of fecretion in the human body is in
general'little undei'ftood, and in no inftance lefs fo
than that of the fecretion of oil from blood which
does not appear previoufly to have contained it. It
is poflible, therefore, that our theory of the deficiency
of oil may be in feveral refpects imperfect ; but there
are certain fads that may in the mean time apply t®
the prefent purpofe.

MDCXIV.

Firft, it. is probable, that a deficiency of oil may be
owing to a ilate of the blood in animal bodies lefs fit-
ted

only

This is one of the incurable fpccies of emaciation, and it
be relieved by a very nutritious and invigorating diet,

O F P H Y S I C. 199

ted to afford a fecretion of oil, raid confequcntly to
fupply the wade of it that is . conftantly made. This
flate of the blood mufl cfpecially depend upon the
ftate of the aliments taken in, as containing lefs of oil
or oily matter. From many observations made, both
\vith refpeft to the human body and to that of other
animals, it appears pretty clearly, that tht> aliments
taken in by men and domeftic animals, according as
they contain more of oil, are in general more nu
ous, and in particular are better fitted to fill the cellu-
lar texture of their bodies with oil. ! might illuflrate
this, by a minute and particular confideratidn ot the
difference of alimentary matters employed ; but it will
be enough to give two inftances. The one ;s, that
the herbaceous part of vegetables, does not fatten -i-
nimals, fo much as the feeds of vegetables, which rna-
nifeftly contain in any given weight a greater propor-
tion of oil ; and a fecond inilaace is, that in general
vegetable aliments do not fatten men fo much as ani-
rnal food, which generally contains a larger propor-
tion of oil.

It will be obvious, that upon the fame principles a
want of food, or a lefs nutritious food, may not
only occafion a general deficiency of fluids (MDCIV.)
but mufi alfq. afford lefs oil, to be poured into the cel-
lular texture. In fuch cafes, therefore, the, emacia-
tion produced, is to be attributed to both thefe general
caufes*.

MDCXV.

A fecond cafe of the deficiency of oil may be ex-
plained in this manner. It is pretty manifefl, thac
the oil of the blood is facreted and deposited in the
cellular texture in greater or leffcr quantity, according
as the circulation of the blood is faller or flower ; and

P p 2 therefore

* The cure of this fpccies of emaciation will bs be ft cfFv^cd by
9 rich die3* of animal food.

3co PRACTICE

therefore that exercife, which h aliens the circula-
tion of the blood, is a frequent caufe of emaciation.
Exercife produces this effect in two ways, ift, By in-
crealing the perfpiration, and thereby carrying off a
greater quantity of the nutritious matter, it leaves lefs
of it to be depofited in the cellular texture ; thereby
not only preventing an accumulation of fluids, but, as
I have faid above, caufmg a general deficiency of thefe,
which mud alfo caufe a deficiency of oil in the cellu-
lar texture, adly, It is well known, that the oil de-
pofited in the cellular texture is upon many occafions,
and for various purpofes of the ceconomy, again ab-
f orbed, and mixed or diffufed in the mafs of blood, to
be from thence perhaps carried entirely out of the bo-
dy by the feveral excretions. Now, among other pur-*
pofes of the accumulation and re-abforption of oil,
this feems to be one, that the oil is requifite to the pro^
per action of the moving fibres in every part of the
body ; and therefore that nature has provided for an
abfcrption of oil to be made according as the action
of the moving fibres may demand it. It will thus be
obvious, that the exercife of the mufctilar and moving
fibres every where, mud occafion an abforption ,of
oil ; and confequcntJy that fuch exercife nor only pre«
vents the fecretion of oil, as has been already faid,
but may alfo caufe a deficiency of it by occafion ing
an abforption of what had been depofited ; and in
this way, perhaps efpecially, does it produce emacia-
tion*.

MDCXVI.

A. third cafe of the deficiency of oil may occur
from the following caufe. It is probable, that one
purpofe of the accumulation of oil in the cellular tex-
ture of animals is, that it may, upon occafion, be again

abforbed

* Abftinence from too fevtre exercife is the only cure for this
fpecies of the difeafe.

O F P H Y S I C. 301

abforbed from thence, and carried into the mafs of
blood, for the purpofe of enveloping and correcting
any unufual acrimony arifing and exifting in the (late
of the fluids. Thus, in mod inftnnces in which we
can difcern an acrid flare of the fluids, as in fcurvy,
cancer, fyphilis, poifons, and feveral other difeafes,
we find at the fame time a deficiency of oil and an
emaciation take place ; which, in my appreheniion,
rnuft be attributed to the abforption of oil, which the
prcfence of acrimony m the body excites.

It is not unlikely that certain poifons introduced in-
to the body, may fubfift there; and. giving occafion
to an abforption of oil, may lay a foundation for the
Tabes a veneno*, Sauv. fp. 17.

MDCXVII.

A fourth caufe of emaciation, and which I would
attribute to fudden and confiderable abforption of oil
from the cellular texture, is that of fever, which fo
generally produces emaciation. This may perhaps
be in part attributed to the increafcd perfpiration,
and therefore to the general deficiency of fluids that
may be fuppofe.d to take place: but whatever ihare
that may have in producing the effecl, we can, from
the evident Shrinking and diminution of the cellular
fubflance, wherever it falls under our observation,
certainly conclude, that there has been a very confi-
derable abforption of the oil which had been before
depofited in that fubfcance. This explanation is ren-
dered the more probable from this, that I fuppofe the

absorption

* As this kind of emaciation proceeds from various eaufes, the
pra&itioner, mult, (after haying afcercained the true caufe) endea-
vour to remove it: and this mull be left entirely to his own fagacity.
It may however be proper to obfervc, that feveral of thefe emacia-
tions proceed from incurable difeafes ; as from Cancer, Scrophula,
•See- and confequently admit of no cure : And thofc emaciations
Which proceed from fcurvy, fypljilis, or thofe difeafes which we can
£iire, arcQnly to be cured by curing the primary dtfeafc.

302 PRACTICE

abforpticxn mentioned is necefiarily made for the pur-
pofe of enveloping or corre&ing an acrimony, which
iiianifcftly does in many, and may be fufpecled to
arife in all cafes of fever.* The moil remarkable in-
itance of emaciation occurring in fevers, is that which
appears in the cafe of he&ic fevers. Here the emaci-
ation may be attributed to profufe fweatings that com-
monly attend the difeafc: but there is much reaibn
to believe, that an acrimony is preient in the blood ;
which, even in the beginning of thedifeafe, prevents
the fecretion and accumulation of oil ; and in the
more advanced Rates of it, muft occafion. a more con-
ftderable abforption of it ; which, from the Shrinking
of the cellular fubftance, feems to go farther than in
almoit any other inftance*.

Upon the fubjecl of emaciations from a deficiency
of fluids, it may be obierved, that every increafed
evacuation excites an abforprion from other parts,
<!iid particularly from the cellular texture; and it is
therefore probable, that a deficiency of fluids, from
increafed evacuations, produces an emaciation, not
only by the waile of the fluids in the vafcuiar fytiem,
but alfo by occafioning a conliderable abforption from
the cellular texture.

MDCXVIII.

I have thus endeavoured to explain the feveral cafes
and caufes of emaciation ; but 1 could not profecute
the consideration of thefe here in the order they are
fet down in the Methodical Nofology. Jn that work
I was engaged chiefly in arranging the fpecies of Sau-
vagcs ; but it is my opinion now, that the arrange-
ment there given is erroneous, in both combining and
feparating fpecies improperly : and it feems to me

more

* This emaciation is purely fymptomatic, and confequently can-
not be cured hut by removing the primary difeafe, and a fubf'.quent
very nutritious diet, confiiling chiefly of anitr.aj food.

,0 F PHYSIC, 303

more proper here to take notice of difeafes, and pun
them together, according to the affinity of their na-
ture, rather than by that of their external appearances.
I doubt, if even the diftinclion of the Tabes and Atro-
phia, attempted in the Noiblogy, will properly apply ;
as 1 think there are certain difeafes of the fame nature,
which fometimcs appear with, and fonietimes with-
out, fever.

MDCXIX.

After having confidered the various oafes of ema-
ciations, I ihould perhaps treat of their cure : but it
will readily appear, that the greater part of the cafes
above-mentioned are purely fymptomatic, and confc-
quently that the cure of them mull be that of the pri-
mary difeafes upon which they depend. Of thole ca-
fes that can any wile be coniidered as idiopathic, it
will appear that they are to be cured, entirely by re-
moving the remote caufes ; the means of accomplifti-
ing which muft be fufficiently obvious.

BOOK It.

O F

INTUMESCENTI .&>

O R

GENERAL SWELLINGS.

MDLXX.

THE fwellings to be treated of in this place arc
thofe which extend over the whole or a great
part of the body ; or fuch at lead, as, though of ihiaii

extent;

304 PRACTICE

extent, are however of the fame nature with triofe that
are more generally extenckd.

The fvvtrl lings comprehended under this artificial
order, are hardly to be diflinguifhed from one another
other wife than by the matter they contain or conflft
of: and in this view I have divided the order into four
feclicns, as the fwelling happens to contain, i//, Oil ;
2d, Air ; yl, A watery fluid ; or 4^, As the increafed
bulk depends upon the enlargement of the whole fub-
Ibince of certain parts, and particularly of one or more
of the abdominal vifcera.

CHAP. I.

OF ADIPOSE SWELLINGS.

MBCXXL

E only difeafe to be mentioned in this chapter,
J[ I have, with other Nofologiils, named Polyfar-
cia ; and in Englifh it may be named Corpulency, or,
more fir icily Obeiity ; as it is placed here upon the
common fuppbfition of its depending chiefly upon the
increafe of oil in the cellular texture of the body.
This corpulency, or obefity, is in very different de-
grees in very different perfons, and is often confider-
able without being coniidercd as a difeafe. There is?
however, a cemiii degree of it, which will be gene-
rally allowed to be a difeafe ; as, for example,, when
it rrnders per funs, fro in a difficult refpiratiqn, uneafy
in themfelves, and, from the inability of exercife, un-
lit for discharging the duties of life to others : and
for that reafon 1 have given fuch a difeafe a place here.
Many phyiicians have coniiclered it as an object of

practice,

OF PHYSIC. 303

pradice, and as giving, even in no very high degree,*
a diipoficion to many difeafes ; I am of opinion that it
mould be an object of practice more frequently than it:
has beert, and therefore that it merits our confidera-
tion here.

MDCXXII.

It may perhaps be alledged, that I have not beeri
fufficiently correct, in putting the difeafe of corpulen-
cy as an intumefcentia pinguedinofa, aiid therefore
implying its being an increafe of the bulk of the bo-
dy from an accumulation of oil in the cellular texture
only. I am aware of this objection : and as I have al-
ready faid, that emaciation (MDCII.) depends either
upon a general deficiency of fluids in the vafcular fyi-
tern, or upon a deficiency of oil in the cellular tex-
ture ; io 1 mould perhaps have obferved farther, that
the corpulency, or general fulnefs of the body, may
depend upon the fulnefs of the vafcular fyftem as well
as. upon that of the cellular texture. This is true ;
and for the fame reafons I ought, perhaps, after Lin-
naeus and Sagar, to have fet down plethora as a parti-
cular difeafe, and as an inftance of morbid intume-
fcence. I have, however, avoided this, as Sauvages
and Vogel have done ; becaufc I apprehend that ple^
thora is to be confidered as a ftate of temperament
only, which may indeecf difpofe to difeafe ; but not as
a difeafe in itfelf, unlefs, in the language of the Statu
Hans, it be a plethora commota, when it produces a
difeafe accompanied with particular fyrnptoms, which
give occiifion to its being diftinguifhed by a different
appellation. Further., it appears to me, that the
fymptoms which Linnaeus, arid more particularly
thofc which Sagar employs in the character of pletho*
ra, never do occur but when the intumefcentia pin-
guedinofa has a great mare in producing them. It is,
however, very neceflary to obferve here, that plethora
and obeiity are generally combined together; an$ that

VOL. II. Q^q iii

3c6 PRACTICE

f

infome cafe.? of corpulency it may be difficult to dc*
termine which of the caufes has greateft fhare in pro-
ducing it. It is indeed very poffible that a plethora
may occur without great obeiity; but I apprehend
that obefity never happens to a confiderable degree
without producing a plethora ad fpatium in a great
part of the fyftem of the aorta, and therefore a pletho-
ra ad molcm in the lungs, and in the vefTels'of the
brain.

MDCXXIII.

In attempting the cure of polyfarcia, I am of opi-
nion that the conjunction of plethora and obefity, in
the manner juft now mentioned, fhould be conllantly
attended to ; and when the morbid effects of the ple-
thoric habit are threatened, either in the head or lungs,
that blood-letting is to be practifed : but at the fame
time it is to be obferved, that pedbns of much obefi-
ty do not bear blood-letting well ; and when the cir-
cumilances I have mentioned do not immediately re-
quire it, the practice upon account of obeiity alone,
is hardly ever to be employed. The fame remark is
to be made with refpect to any other evacuations that
may be propofed for the cure of corpulency : for with-
out the other means I am to mention, they can give
but a very imperfe6t relief; and, in fo far as they ei-
ther empty or weaken the fyftem, they may favour
the return of plethora, and the increafe of obeiity.

MDCXXIV.

Polyfarcia, or corpulency, -whether it depend upon
.plethora or obeiity, whenever it either can be confi-
dered as a difeaie, or threatens to induce one, is to be
cured, or the effects of it are to be obviated, by diet
and exercife. The diet mufi be fparing; or rather,
what is more admirable, it inuft be fuch as affords lit-
tle nutritious matter. It nuift therefore be chieily, or
alraott only, of vegetable matter, and at the very ut-
( mi'lk. Such a diet fhould be employed, and

generally

O F P H Y S I C. 307

generally ought to precede exercife : for obefity does
not eaiily admit of bodily exercife ; 'which is, h
ver, the only mode that can be very effectual. Such,
indeed, in many cafes, may feem difficult to be admit-
ted; but I am of opinion, that even the mod corpu-
lent may be brought to bear it. by at fir ft attempting
it very moderately, and -increasing it by degrees very
flowly, but at the fame time perfntmg in fucli at-
tempts with great conftancy*.

MDCXXV/

As thefe, though the only effectual meafures, are
often difficult to be admitted or carried into execu-
tion, fome other means have been though: of and em-
ployed for reducing corpulency. Thefe, if 1 mi flake
not, have all been certain methods of inducing a falinc
Hate in the mafs of blood ; for fuch I fuppole to be
the effects of vinegar and of foap, which have been
propofed. The latter, 1 believe, hardly pafies into
the blood-veffels, without being revived and formed
into a neutral fait, with the acid which- it meets with
in the flomach. How well acrid and faline fubftanc-
es are fitted to diminish obefity, may appear from
what has been faid above in MDCXV. What effects
vinegar, foap, or other fubftances employed, have
had in reducing corpulency, there have not proper
opportunities of obferving occurred to me : but I am
well perfuaded, that the inducing a faline and acrid
flate of the blood, may have worfe confequences than
the corpulency it was intended to correct ; and that
no perfon Should hazard thefe, while we may have re-
courfe to the more fare and certain means of abfti-
nence and exercife.

CHAP.

* Befides tlie means mentioned by th.e author, evacuations of
4ifFe ent kinds ought to be aecafi«na!'y made> efpecially by
and f\yeatin£.

3o3 PRACTICE

CHAP. II.

OF FLATULENT SWELLINGS.

MDCXXVI.

THE cellular texture of the human body very rea-
dily admits of air, and allows the fame to pafs
from any one to every other part of it. Hence Em-
phyfemata have often appeared from air collected in
the cellular texture under the fkin, and in feveral
other parts of the body. The flatulent fwellings un-
der thefkin, have indeed mod commonly appeared in
confequence of air immediately introduced from with-
out : but in, fome inftances of flatulent fwellings, efpe-
cially thofe of the internal parts not communicating
with the alimentary canal, fuch an introduction can-
not be perceived or fuppofed ; and therefore, in thefe
cafes, fome other caufe of the production and collcc*
tion of air muil be looked for, though it is often not
to be clearly afcertained.

In every folid as well as every fluid fubftance which
makes a part of the human body, there is a confidera-
ble quantity of air in a fixed flate, which maybe again
reftored to its elaftic flate, and fcparated from thofc
fubftances, by the power of heat, putrefaction, and
perhaps other caufes : but which of thefe may have
produced the feveral inftances of pneumatofis and fla-
tulent fwellings that have been recorded by authors, I
cannot pretend to afcertain, ' Indeed upon account
of thefe difficulties, I cannot proceed with any clear-
nefs on the general iubjecl of pneumatofis ; and there-
fore, with regard to flatulent fwellings, I find it ne-
ceflary to confine myfelf to the coniideration of thofe
of the abdominal region alone ; which I ihall now treat
of under the general name of Tympanites..

MBCXXVH,

OF PHYSIC. 509

MDCXXVII.

The tympanites is a f welling of the abdomen ; in
which the teguments appear to be much flrctched by
fome diftcnding power within, and equally ftretched
in every polture of the body. The fwelling does not
readily yield to any prelTure ; and in fo far as it does,
very quickly recovers its former ftate upon the preffure
being removed. Being ilruck, it gives a found like a
drum, or other firetched animal membranes. No
fluctuation within is to be perceived ; and the whole
feels Jefs weighty than might be expected from its bulk-
The uneafinefs of the diilenlion is commonly relieved
by the difcharge of air from the alimentary canal,
either upwards or downwards.

MDCXXVIII,

Thefe are the characters by which the tympanites
may be diftinguiflied from afcites or phyfconia ; and
many experiments fhow, that the tympanites always
depends upon a preternatural collection of air, fome-
where within the teguments of the abdomen ; but
the feat of the air is in different cafes fomewhat dif-
ferent ; and this produces the different fpecies of the
difeafe.

One fpecies is, when the air collected is entirely
confined within the cavity of the alimentary canal, and
chiefly in that of the inteftines. This fpecies, there-
fore, is named the tympanites inteftinalis^ Sauv. fp. i.
It is, of all others, the moil common; and to it efpe-
cially belong the characters given above. •

A fecond fpecies is, when the air collected is ngt
entirely confined to the cavity of the inteftines, but is
alfo prefent between tfyeir coats ; and fuch is that
which is named by Sauvages Tympanites enter Qphyfodes.,
Sauv. fp. 3. This has certainly been a rare occur-
rence ; and has probably occurred only in confe-
quence of the tympanites infytinalit^ by the air efcap-
jng from the cavity of the inteftines into the inter-

flices

3iQ PRACTICE

flices of the coats. It is, however, poffible that an
erofion of the internal coat of the interlines may give
occafion to the air, fo coniLmtly prefent in their cavi-
ty, to efcape into the interiticcs of their coats though
in the whole their cavity there has been no previous
accumulation.

A third fpecies is, when the air is collected in the
fac of the peritonaeum, or what is commonly called
the cavity of the abdomen, that is, the fpace between
the peritonaeum and vifcera ; and then the difeafe is
named tympanites abdominalis-j Sauv. fp. 3. The ex-
iftence of fuch a tympanites, without any tympanites
inteftinaliSi has been difputed ; and it certainly has
been a r<ire occurrence ; but from feveral directions,
it is unqueftionable that fuch a difeafe has fometimes
truly occurred.

A fourth fpeeies of tympanites is, when the tympa-
nites inieftinalis and aM^ni nails are joined together,
or take place at the fame time. With refpect to this,
in is probable that the tympanites inteftinalis is the pri-
mary difeafe ; and the* other, only a confequence of
the air efc iping, by an erofion or rupture of the coats
of the inteftines, from the cavity of thefe into that of
the abdomen. It is indeed pofTible, that in confe-
quence of erofion or rupture, the air which is fo cor*-
ilantiy prefent in the inteftinal canal, may cfcape
from thence in fuch quantity into-the cavity of the ab-
domen, as to give a tympanites abdominalis, whilfi there
was no previous confiderable accumulation of air in
the inteftinal cavity itfelf ; but I have not facts to af-
certain this matter properly.

A fifth fpecies has alfo been enumerated. It is
when a ivmpanites abdominalis happens to be joined
with the hydrops af cites ; and fuch a difeafe therefore
is named by Sauvages tympanites afciticus^ Sauv. fp. 4-
In moft cafes of tympanites, indeed, fome quantity of
fcrum has, upon direction, -been found in the fac of

O F P H Y S I C. 3ir

the peritonaeum ; but that is not enough to conftitute
the fpecies now mentioned, and when the collection
of ferum is mure confidfcrable, it is commonly where,
both from the caufes which have preceded, and likcwifc
from the fymptoms which attend., the afcites may be
confidered as the primary difeafe ; and therefore that
this combination does not exhibit a proper fpecies of
the tympanites.

MDCXXIX.

As this laft is not a proper fpecies, and as fome of
the others are not only extremely rare$ but even when
occurring, are neither primary, nor to be eafily diftin-
guifhed, nor, as confidered in themfelves, admitting
of any cure, I fliall here take no further notice of
them ; confining myfeif in what follows, to the con-
ii deration of the moil frequent cafe, and. almoft the
only object of practice, the tympanites inteftinalis.
MDCXXX.

With refpect to this, I cannot perceive that it arifo*
in any peculiar temperament, or depends upon any
predifpofition, which can be difcerned. It occurs in
cither fex, at every age, and frequently in young per-
fons.

MDCXXXI.

Various remote caufes of it have been affigncd ; but
many of thefe have not commonly the effecl of pro-
ducing this difeafe ; and although fome of them have
been truly antecedents of it, I can in few inftances
difcover the manner in which they produce the difeafe,
a,nd therefore cannot certainly afccrtain them to have
been caufes of it.

MDCXXXII.

The phenomena of {his difeafe in its feveral ftagcs
are the following.

The tumor of the belly fcmetimes grows very
quickly to a confiderable degree, and feldom in the
flow manner the afcites common Incomes on. In uxr.e

cafes,

312 PRACTICE

cafes, however, the tympanites comes on gradually^
and is introduced by an unufual flatulency of the fto-
mach and inteftines, with frequent borborygmi, and
an uncommonly frequent expullion of air upwards and
downwards. This ftate is alfo frequently attended
with colic pains, efpecially felt about the navel, and
upon the fides towards the back ; but generally as
the difeafe advances, thefe pains becomes lefs confi-
derable. As the difeafe advances, there is a pretty
conftant defire to difcharge air, but it is accomplimed
\vith difficulty^; and when obtained, and although it
gives fome relief from the fenfe of diftenfion, this re-
lief is commonly tranlient and of fhort duration. —
While the difeafe is coming on, fome inequality of tu-
mour and teniion may be perceived in different parts
of the belly; but the dilteniion foon becomes equal
over the whole, and exhibits the phenomena mention-
ed in the character. Upon the firft coming on of the
difeaie, as well as during its progrefs, the belly is
bound, and the faeces difcharged are commonly hard
and dry. The urine, at the beginning, is ufually ve-
ry little changed in quantity or quality from its natu-
ral ftate : but as the difeafe continues, it is commonly
changed in both refpects ; and at length fornetimes
a ftranguary, and even an ifchuria, comes on. The
difeafe has feldom advanced far, before the appetite is
much impaired, and digeilion ill performed ; and the
' whole body, except the belly, becomes confidently
emaciated. Together with thefe fymptoms, a thirit
and uneafy fenfe of heat at length comes on, and a
conficierably frequency of pulfe occurs, which conti-
nues throughout the courfe of the difeafe. When the
tumor of the belly arifes to a conliderable bulk, the
breathing becomes very difficult, with a frequent dry
cough. With all thefe fyrnptoms the ftrength of the
patient declines; and the febrile fymptoms daily
increaiihcr death at leneth en llues, fometimes proba-

bly

O F P H Y S I C. 313

My in coafequence of a gangrene coming upon the
inteftines.

MDCXXXIH.

The tympanites is commonly of fome duration, and
to be reckoned a chronic difeafe. Jt is very feidom
quickly fatal, except where fach an affedion fudden-
ly arifes in fevers. To this Sauvages has properly
given a different appellation, that of Meteor if mus ; and
I judge it may always be conftdered as a fyniptomatic
affection, entirely diilind from the tympanites we ate
now coniidering.

MDCXXXIV.

The tympanites is generally a fatal difeafe, feidom
admitting of cure; but what may be attempted in this
way, I iriall try to point out, after I fhall have endea-
voured to explain the proximate caufe, which alond
can lay the foundation of what may be rationally at-
tempted towards its cure.

MDCXXXV.

To ascertain the proximate caufe of tympanites, is
fome what difficult. It has been fuppofed in many
cafes, to be merely an uncommon quantity of air pre-
fent in the alimentary canal, owing to the extrication
and detachment of a greater quantity of air than ufu-
al from the alimentary matters taken in. Our vegeta-
ble aliments, I believe, always undergo fome degree of
fermentation ; and in confequence, a quantity of afir is
extricated and detached from them in the ftomach
and inteftines ; but it appears that the mixture of the
animal fluids which our aliments meet with in the ali-
mentary canal, prevents the fame quantity of air from
being detached from them that would have been in
their fermentation without fuch mixture ; and it is
probable that the fame mixture contributes alib to the
reabforption of the air that had been before in fome
meafure detached. The extrication, therefore, of an
imufual quantity of air from the aliments, may, in

VOL. II. R r

3H PRACTICE

«

tain circumftances, be fuch, perhaps, as to produce' £
tympanites: fo that this difeaie may depend upon a
fault of thedigeftive fluids, whereby they are unfit to
prevent the too copious extrication of air, and unfit al-
ib to occafion that reabforption of air which in found
perfons commonly happens. An unufual quantity of
air in the alimentary canal, whether owing to the na-
ture of the aliments taken in, or to the fault of the
digefkive fluid, does certainly fometimes take place;
and may poffibiy have, and in fome meafure certainly
has, a mare in producing certain flatulent diforders of
the alimentary canal ; but cannot be fuppofed to pro-
duce the tympanites, which often occurs when no
previous diibrder had appeared in the fyftem. Evea
in thofe cafes of tympanites which are attended at
their 'beginning with flatulent diforders in the whole of
the alimentary canal, as we know that a firm tone of
the interlines both moderates the extrication of ak
and contributes to its leabforption or ready expulfion,
fo the flatulent fymptcms which happen to appear at
the coining en of a tympanites, are, in my opinion, to
be referred to a lofs of tone in the mufcular fibres of
the inteiiines, rather than to any fault in the digeftivc
fluids.

MDCXXXVL

Thefe, and other confiderations, lead me to con-
clude, that the chief part of the proximate caufe of
tympanites, is a lofs of tone in the mufcular fibres of
the interlines. But further, as air of any kind accu-
mulated in the cavity of the inteiiines mould, even by
its own elailicity, find its way either upwards or down-
wards, and fliould alfo, by the affifhatice of infpira-
tioir, be entirely thrown out of the body ; fo, when
neither the reabforption nor the expulfion takes place,
and the air is accumulated fo as to produce tympan-
ites, it is probable that the pafTage of the air along
the courfe of the inteftines is in fome places of thefe

inter-

OF PHYSIC. 315

interrupted. This interrupt ion, However, caii hardly
be fuppofed to proceed from any other caufe than
fpafmodic conditions in certain parts of the canal;
-and I conclude, therefore, th.it fuck c mitricUons con*
cur as part in the proximate cauic ot tympanites. —
Whether thefe fpafmodic conductions are- to bp attri-
buted to the remote caufe of the difeafc, or may be
confidered as theconfequence of f >me degree of atony
fird ariiing, I cannot with certainty, and do not find it
ncceflary to determine.

MDGXXXVII.

Having thus endeavoured to afcertain the proxi-
mate caufe of tympanites, I proceed to ticat of its
cure ; which indeed has fcldom fucceeded, and al-
jnod never but in a recent difeafe. I mud, however,
endeavour to fay what may be reafonably attempted;
what has commonly been attempted ; and what at-
temprs have fometimes fucceeded in the cure of this
difcafe.

MDCXXXVI1I.

It mud be a fird indication to evacuate the. air ac-
cumulated in the interlines : and for this purpofe it is
neceflary that thofe conftric"lions, which had especially
occafioned its accumulation, and continue to inter-
rupt its. paifage along the courie of the inteftines
fhould be. removed. As tlic-fe, Jiowcver, «an hardly
be removed but by exciting the perid«-:itic motion in
the adjoining portions of the inreflines, purgatives
have beer, commonly employed ;. but it is at the fame
time agreed, that the more gentle laxatives only ^ught
to be employed, as the more drafuc, in the overftretch-
ed and tenfe flate of the intedines, arc in danger of
bringing on inflammation.

It is for this reafon, alf>, that glyucrs have been .
frequently employed ; and they are the more necefla-
ry, as the faeces collected are generally found to be in
a hard and dry date. Not only upon account of this

R r 2 - date

3i6 PRACTICE

Hate of the faeces, but, farther, when glyfters produce
a confiderable evacuation of air, and thus fhow that
they have fome effect in relaxing the fpafms of the
inteftines, they ought to be repeated very frequently.
MDCXXXIX.

In order to take off the conftridions of the intef-
tines, and with fome view alfo to the carminative ef-
fecls of the medicines, various antifpafmodics have
been propofed, and commonly employed ; but their
effects are feldom confiderable, and it is alledged that
their heating and inflammatory powers have fome-
times been hurrful. It it, however, always proper to,
join fome of the milder kinds with both the purgatives
and glyflers that are employed* ; and it has been ve*
ry properly advifed to give always the chief of antif-
pafmodics, that is, an opiate, after the operation of
purgatives is finifhed,

MDCXL.

In confideration of the overftretched tenfe, andcjry
ftate of the inteftines, and efpccially of the fpafmodic
conftrictions that prevail, fomentations and warm
bathing have been propofed as a remedy ; and are
faid to have been employed with advantage : but
it has been remarked, that very warm baths have no£
been found fo ufeful as tepid baths long continued,
MDCXLI.

Upon the fuppofition that this difeafe depends efpe-
-cially upon an atony of the alimentary canal, tonic re-
medies

* The antifpafmodics that are to be joined with purgatives ought
to be efTential oi'K efpec'ally the effential oils of umbelliferous
plains, as oil of anifeed, oil ofcarui, £c. and their dofe ought to be
moderate. In many cafes they may be ufed in repeated fmall dofes
by themfelves on a piece of fugar. The dofe of the ol. anifi ought ,
wot to exceed ten pr twelve drops, nor of the ol. carui nve drops ;
larger dofes are too heating. It may be proper alfo to obferve, that
the effential oils of the verticellated plants, .as mint, marjoram,
thyme, &c. are much too heating, and much more fo thofe oi the
aromaticS) as cloves, cinnamon, &c.

O F P H Y S I G.

medics feem to be properly indicated. Accordingly
chiilybeatcs, and various bitters, have been employed ;
and, if any atonic*, the Peruvian bark might probably
be ufeful.

MDCXLII,

But as no tonic remedy is more powerful than cold
applied to the furface of the body, and cold drink
thrown into the ftomach ; fo fuch a remedy has been
thought of in this difeafe. Cold drink has been con-
ftantly prefcribed, and cold bathing has been employed
with advantage; and there have been federal in-
flarsces of the difeafe being fuddenly and entirely cur-
ed by the repeated application of fnow to the lower
belly:

MDCXLIIL

It is hardly neceiTary to remark, that, in the diet of
tympanitSc perfons, all forts of food ready to become
flatulent in the ftomach are to be avoided ; and it is
probable, that the foffil acids and neutral (kits, as an-
tizymics, may be ufefulj.

MDCXLIV.

In obflinate and defperate cafes of tympanites, the
operation of the paracentefis has been propofed : but
it is a very doubtful remedy, and there is hardly anr
teftimony of its having been practifed with fuccefs.
It mud be obvious, that this operation is a remedy
fiiited efpecially, and almoft only, to the tympanites
abdominalis ; the exiftence of which, feparately from
the inteflinaUs, is very doubtful, at leaft not ealily af-
certained. Even if its exiflence could be afcertained,
yet ic is not very likely to be cured by this remedy ;

and

* The author here furely tr»eant to fay tonic ; and atonic feems
to be a typographical error ; but it was fo printed in the lad edition
publilhed before his death.

§ The foffil acids arc undoubtedly very powerful in refilling fer-
mentation ; and if the air in the fnteltines 1*5 produced by fermenta-
tion, they are con fervently highly ufefuL

3i3 PRACTICE

and how far the operation might be fafe in the tympan-
ites inteftinalis, is not yet determined by any propey
experience.

CHAP. III.
OF WATERY SWELLINGS, OR DROPSIES.

MDCXLV.

A PRETERNATURAL colkaion of ferous or
watery fluids, is often formed in different parts
of the human body ; and although the difeafe thence
nrifmg he diflinguiiried according to the different
parts which it occupies, yet the whole of fuch collec-
tions come under the general appellation of Dropiits.
At the fame time, although the particular inflances
of fuch colledion are to be diftinguiihed from each
other according to the parts they occupy, as well as by
other circumilances attending them; yet all of them
feem to depend upon fome general caufes, very much
in common to the whole. Before proceeding,
therefore, to confider the feveral fpecies, it may be
proper to endeavour to affign the general caufes of
dropfy.

MDCXLVL

In perfons in health, a ferous or watery fluid ftem?
to be conftantly poured out, or exhaled in vapour, in-
to every cavity and interface of the human body ca-
pable of receiving it ; and the fame fluid, without re-
maining long or being accumulated in thefe fpaces,
feems conftamly to be foon again abfoibed frors
thence by veflels adapted to the purpofc. From this

OF PHYSIC. 319

View or the animal ceconomy, it will be obvious, that
if the quantity poured out into any fpace, happens
to be greater than the abforbents can at the fame
time take up, an unufual accumulation of ferous fluid
will be made in fuch parts ; or though the quantity
poured out be not more than ufual, yer if the abforp-
tion be any wife interrupted or diminished, from this
caufe alfo an unufual collection of fluids may be occa-
iioned.

Thus, in general, dropfy may be imputed to an
increafed efYuiicn, or to a diminifhed abforption ; and
I therefore proceed to inquire into the feverai caufes
of thefe.

MDCXLVII.

An increafed effuiion may happen, either from a
preternatural increafe of the ordinary exhalation, or
from the rupture of veifels carrying, or of facs con-
taining, ferous or watery fluids.

MDCXLVIII.

The ordinary exhalation may be increafed by vari-
ous caufes, and particularly by an interruption given
to the free return of the venous blood from the ex-
treme veflels of the body to the right ventricle of the
heart. This interruption feems to operate by refitting
the free pailage of the blood from the arteries into the
veins, thereby increafing the force of the arterial flu-
ids in the exhalants, and confequently the quantity of
fluid which they pour out.

MDCXLIX.

The interruption of the free return of the venous
blood from the extreme veiTels, may be owing to cer-
tain circumftances affecting the courfe of the venous
blood ; very frequently, to certain conditions in the
righc ventricle of the heart itfelf, preventing it from
receiving the ufual quantity of blood from the vena
eava ; or to obftruclions in the veffels of the lungs pre-
venting the entire evacuation of the right ventricle,

and

32o PRACTICE

and thereby hindering its receiving the ufaal quan-
tity of blood from the cava. Thus, a polypus in the
right ventricle of the heart* and the oflitication of its
valves, as well as all confiderable and permanent cb-
ilruclions of the lungs, have been found to be caufes
of dropfy.

MDCL.

It may ferve as an illuftration of the operation of
thefe general caufes, to remark, that the return of the
venous blood is in fome meafure refitted when the
pofture of the body is fuch as gives occafion to the
gravity of the blood to oppofe the motion of it in the
veins, which takes effect when the force of the circu-
lation is weak ; and from whence it is that an upright
pofture of the body produces or increafes ferous fwell-
ings in the lower extremities.

MDCLL

Not only thofe caufes interrupting the motion of
the venous blood more generally, but, farther, the in-
terruption of it in particular veins, may likewife have
the effect of increafing exhalation, and producing
dropfy. The moil remarkable mitance of this is,
•when confiderable obfh'uclioris of the liver prevent
the blood from flowing freely into ic from the. vena
portaium and its numerous branches ; and hence thefe
obftruclions are a frequent caufe of dropfy.
MDCLIL

Scirrhofitics of the fpleen and other vifcera, as well
as the fcirrhofity of the liver, have been confuiered
as caufes of dropfy ; but the manner' in which they
can produce the difeafe, I do not perceive, except it
may be where they happen to be near fome confider-
able vein, by the compreffion of which they may oc-
cafion fome degree of afcites ; or, by completing the
vena cava, may produce an anafarca of the lower ex-
tremities. It is indeed true, that fcirrhofities of the
fpleen and other vifcera, have been frequently difco-

v -red

O F P H Y S I C. 321

vered iii the bodies of hydropic perfons : but I be-
lieve they have .been ieldom found unlefs when fcir-
rhofities of the liver were alfo prefent ; and I am in-
clined to think, that the former have been the effects
of the latter, rather than the caufe'of the dropfy ; or,
that, if fcirrtioriries of the other vifcera have appeared
in hydropic bodies when that of the liver was not pre-
fenr, they muft have been the effects of fome of thofe
caufes of dropfy to be hereafter mentioned ; and con-
fequently to be the accidental attendants, rather than
the caufes, of fuch dropiies.

MDCLIII.

Evert in fmaller portions of the venous fyfleni, the
interruption of the morion of the blood in particular
veins has had the fame effect. Thus a polypus form-
ed in the cavity of a vein, or tumours formed in its
coats, preventing the free pafTageof the blood through
it, have had the effect of producing dropfy in parts to-
wards the extremity of fuch veins.
MDCLIV.

But the caufe mid frequently interrupting the mo-
tion of the blood through the veins is, the compreffi-?
ori of tumours exiiting near to them; fuch as aneu-
rifrns in the arteries, abfceifes, and fcirrhous or fteato
matous tumours in the adjoining parts.

To this head may be referred the comprefiion of
the defccnding cava by the bulk of the uterus in preg-
nant women, and the compreffion of the fame by the
bulk of water in the afcites ; both of which comprefli-
ons frequently produce ferous fwellings in the lower
extremities.

MDCLV.

It may be fu.p'pofed, that a general preternatural
plethora of the venous fyftem may have the effect of
increafing exhalation ; and that this plethora may
happen from, the fuppreffion of fluxes, or evacuations
of blood, which had for forae time taken place in the *

VOL, !L S s body,

322 PRACTICE

body, fuch as the menftrual and hemorrhoidal fluxes.
A dropfy, however, from fuch a caufe, has been at
leail a rare occurrence; and when it fecms to have
happened, I fhould fuppofe it owing to the fame caul-,
es as the fuppreilion itfelf, rather than to the pletho-
ra produced by it.

iMDCLVL

» One of the moft frequent caufes of an iricrenfed ex-
halation, I apprehend to be the laxity of the exhalant
veiTels. That fuch a caufe may operate, appears pro-
bable from this, that paralytic limbs, in which fuch a
laxity is to be fufpeded, are frequently affected with
ferous, or, as they are called, cedematous fwellings.

But a much more remarkable and frequent exam-
ple of its operation occurs in the cafe of a general de-
bility of the fyftem, which is fo often attended with
dropfy. That a general debility does induce dropfy,
appears fufficiently from its being fo commonly the
confequence of powerfully debilitating caufes ; fuch
as fevers, either of the continued or intermittent kind,
which have laded long ; long-continued and fome-
what excefiive evacuations of any kinds ; and in mort,
almofb all difeafes that have been of long continu-
ancej and have at the fame time induced the other
fymptoms of a general debility.

Among other caufes inducing a general debility of
tlie fyftem, and thereby dropfy, there is one to be
mentioned as frequently occuning, and that is, in-
temperance in the ufe of intoxicating liquors ; from
whence it is that drunkards of all kinds, and efpsci*
ally dram-drinkers, are fo afFeded with this difcafe.
MDCLVII.

That a general debility may produce a laxity of the
exhalants, wifl be readily allowed : and thar by this
cfpecialJy it occafions dropfy, I judge from thence,
that while mr ft of the caufes already mentioned arc
fulled to produce dro'pfles of particular parts only, the \

flare !

0 F E H Y S I C. 323

(late of general debility gives rife to increafed exhala-
tion into every cavity and interface of the body, and
therefore brings on a general difeafe. Thus, we have
feen effufions of a ferous fluid made, at the fame time,
Into the cavity of the cranium, into that of the thorax
and of the abdomen, and likewife into the cellular tex-
ture almoft over the whole of the body. In fuch caf-
€S, the operation of a general caufe difcovered itfelf,
by thefe feveral dropfies increafmg in. one part as they
diminifhed in another, and this alternately in the dif-
ferent parts. This combination, therefore, of the dif-
ferent fpecies of dropfy, or rather, as.it may be term-
ed, this univerfal dropfy, rauft, I think, be referred to
a general caufe ; and in mod inftances, hardly any o-
ther can be thought of, but a general laxity of the ex-
halants. It is this, therefore, that I call the hydropic
diatbefis ; which frequently operates by itfelf; and
frequently, in fome rneafure, concurring with other
caufes, is efpecially that which gives them their full

This flate of the fyftem, in its firft appearance,
feems to be what has been confidered as a particular
difeafe under the name of Cachexy ; but in every in-
ftance of it that has occurred to me, I have always
confidered, and have always found, it to be the be-
ginning of general dropfy.

MDCLVIIL

The feveral caufes of dropfy already mentioned nriy
produce the difeafe, although there be no preternatu-
ral abundance of ferous or watery fluid in thebloofl-
vefTels ; but it is now to be remarked, that a preterna-
tural abundance of that kind may often give occafioii
to the difeafe, and more efpecially when fuch abun-
dance concurs with the caufes above enumerated.

One caufe of fuch preternatural abundance may be
an unufuai quantity of water taken into. the body.
Thus an unufuai quantity of water takeriin by drink-

S s 2 ing,

PRACTICE

ing, has fome times occailoned a dropfy. Large quan-
tities of water, it is -true, are upon many occafions
taken in ; and being as readily thrown out again by
ftool, urine, or perfpiration, have not produced any
difeafe. But it is alib certain, that upon fome occa-
lions, an unufual quantity of watery liquors taken in
has run off by the feveral internal exhalants, and pro-
duced a dropfy. This feems to have happened, ei-
ther from the excretories not being fitted to throw out
the fluid fo fa ft as it had been taken in, or from the
excretories having been obftru&ed by accidentally
concurring caufes- Accordingly it is laid, that the
fudden taking in of a large quantity of very cold wa-
ter, has produced dropfy, probably from the cold pro-
ducing a conftri&ion of the excretories.

The proportion of watery fluid in the blood may be
increafed, not only by the taking in a large quantity
of water by drinking, as now mentioned, but it is
poffible that it may be increafed alfo by water ta.ken
in from the atmofphere by the ikin in an abforbiag or
imbibing Hate. It is well known that the ikin may
be, at lead, occasionally in fuch a itate ; and it is pro-
bable, that it many cales of beginning dropfy, when,
the circulation of the blood on the fur face of the bo-
dy is very languid, that the ikin may be changed
from a perfpiring to an imbibing ilate ; and thus, at
"leaft, the difeafe may be very much increafed.

MDCLIX

A fecond caufe of a preternatural abundance of wa-
fSty fluids in the blqod-veilels, may be, nn interrup-
tion of the ordinary watery excretions ; and according-
•ly it is alledged, that perfons much expofed to a cold
and moid air are liable to dropfy. It is alfo faid, that
an interruption, or confide ruble diminution, of the
urinary fecretion, has produced the difeafe : and it is
certain, that in the cafe of an tfcburia renalis, the ie-
rofity retained in the b , cilcis has been poured

puc

Of P H Y S I C. 325

out into fome internal cavities, and has occaFicmed

diopfy.

MDCLX.

A third caufe, of an over-proportion of ferous fl'.Usi
in the blood ready to run off by the exhalants, has
been very large evacuations of blood, either fpontane-
ous or artificial. Thefe evacuations, by abfiracling a
large proportion of red globules and gluten, which are
the principal means of retaining; lerum in the red vef>-
fels, allow the ferum to run off more readily by the
exhalants : and hence dropfies have been frequently
the confequence offuch evacuations.

It is poflible alfo, that large and long-continued if-
fues, by abstracting a large proportion of gluten, may
have the fame effecl:.

An over-proportion of the ferous parts of the blood,
may not only be owing to the fpoliation juft now men-
tioned, but may, I apprehend, be likewife owing to
a fault in the digeiling and affimiJating powers in the
itomach and otiier organs ; whereby they do not pre-
pare and convert the aliments taken in, in fuch a
manner as to produce from them the due proportion
of red globules and gluten ; but, flill continuing to
fupply the watery parts, occafion thefe to be in an o-
ver-proportion, and confequently ready to run off in
too large quantity by the exhalants. It is in this
manner that we explain the dropfy, fo often attending
cblorofis : which appears always at firft by a pale co-
lour of the whole body, ihowing a manileft deficien-
cy of red blood ; which in that difeafp can only be
atuibuted to an imperfect digeftion and uffirnilation.
Whether a like imperfection takes place in what
lias been'cailed a Cachexy, 1 dare not determine. This
difeafe indeed has been commonly and very evidently
owing to the general caufes of debility above mention-
ed : and it being probable that the general debility
piay affefl: the organs of digeflion and ailimilation ; fo

the

S2(> PRACTICE

the imperfect ilate of thefe functions, occafioning ^
deficiency of red globules and gluten, may often con-
cur with the laxity of the exhalants in producing
dropfy.

MDCLXI.

Thefe are the feveral caufes of increafed exhalation,
which I have mention?d as the chief caufe of the ef-
fufion producing dropfy ; but I have likewife obferv-
ed in MDCXLVII; that with the fame effect, an effu-
lion may alfo be made by the rupture of veffels carry-
ing watery fluids.

'In this way, a rupture of the thoracic duct, has giv-
en occalion to sin effufion of chyle and lymph into
the cavity of the thorax : and a rupture of the lacte-
als has occafioned a like effufion into the cavity of the
abdomen j and in either cafe, a dropfy has been pro-
duced.

It is fufikiently probable, that a rupture of lympha-
tics, in confequence of drains, or the violent com-
preflion of neighbouring mufcles, has occafioned an
effufion ; which, being diffufed in the cellular texture,
has produced dropfy.

It belongs to this head of caufes, to remark, thr.t
there are many inftances of a rupture or erofion of the.
kidneys, ureters, and bladder of urine ; whereby the
urine has been poured into the cavity of the abdomen,
and produced an afcites.

MDCLXII.

Upon this fubject, of the rupture of veffels carrying,
or of veficles containing, watery fluids, I muft obferve,
that the direction of dead bodies has often mown ve-
iicles formed upon the furface of many of the inter-
nal parts ; and it has been fuppofed that the rupture
offuch veficles, commonly named Hydatides, together
with their continuing to pour out a watery fluid, has
been frequently the caufe of dropfy. I cannot deny

the

OF PHYSIC 327

the poffibility of fuch a caufe, but fufpeft the matter
muft be explained in a different manner.

There have been frequently found, in almofl every
different part of animal bodies, collections of fpherical
veficles, containing a watery fluid ; and in many cafes
of fuppofed dropfy, particularly in thofe called the
preternatural encyfted dropfies, the fvvelling has been
entirely owing to a collection of fuch hydatides. Ma-
ny conjectures have been formed with regard to the
nature arid production of thefe veficles ; but the mat-
ter at lad feems to be afcertained. Ir feems to be cer-
tain, that each of thefe veiicles has within it, or an-
nexed to it, a living animal of the worm kind; which
feems to have the power of forming a veficle for the
purpofe of its own ceconomy, and of filling it with a
watery fluid drawn from the neighbouring parts : and
this animal has therefore been properly named by late
naturalifts, the Ttsnia hydatigma. The ofigin and
ceconomy of this animal, cr an account cf the feverai
parts of the human body which it occupies., I cannot
profecute further here ; but it was proper for me, in
delivering the caufes of dropfy, to fay thus much of
hydatides : and I mull conclude with obferving, 1 am
well perfdaaed, that moll of the inltances of preterna-
tural encyfted dropfies which have appeared in many
different parts of the human body, have been truly
collections of fuch hydatides 5 but how the fvvellings
occafioned by thefe are to be diftinguifhed from other
fpecies of dropfy, or how they are to be treated in
practice, I cannot at prefent determine.
MDCLXIII.

After having mentioned thefe, I return to confider
the other general caufe of dropfy, which I have faid
in MDCXLVI. may be, An interruption or diminution
of the abforption that fhould take up the exhaled flu-
ids from the feverai cavities and interftices of the bo-

dv:

PRACTICE

dy ; the caufes of which interruption, however, are
not eafily afcertaincd.

MDCLXIV.

It Teems probable, that abforption may be diminim-
ed, and even ceafe altogether, from a lofs of tone ia
the abforbent extremities of the lymphatics. . I can-
not indeed doubt that a certain degree of tone or act-
ive power is neceflary in thefe abforbent extremities ;
and it appears probable, that the fame general debili-
ty which produces that laxity of the cxhalant veiTels,
wherein I have fnppofed the hydropic diatheils to con-
lift, will at the fame time occafion a lofe of tone in the
abforbents ; and therefore that a laxity of the exha-
lants will generally be accompanied with a lofs of
tone in the abforber.ts ; and that this will have a mare
in the production of dropfy. Indeed it is probable
that the diminution of abforption has a considerable
ihare in the matter : as dropiies are often cured by
medicines which feem to operate by exciting the acti-
on of the abforbents.

MDCLXV.

It has been fuppofed, that the abforption performed
by the extremities of lymphatics may be interrupted
by an obftruction of thefe veftels, or at lead of the
conglobate glands through which thefe vefiels pafs.
This, however, is very doubtful. As the lymphatics
have branches frequently communicating with one
another, it is not probable that the obft ruction of any
one, or even feveral of thefe^ can have any conficlera-
ble effect in interrupting the abforption of their extre-
mities.

And for the fame reafon it is as little probable that
the obllruclion of conglobate glands can have fuch an
effect : at leaft it is only an obftruction of the glands
of the mefentery, through which fo considerable a por-
tion of the lymph paffes, that can poffibly have the ef-
lect of interrupting abforpticn. But even this we

ihould

OF PHYSIC. 329

not readily fuppofe, there being re.ifon to he-
lieve that thefe glar.as, even in a coniiderably tume-
fied Hate, are not entirely obftrudkd : And according-
ly I have known fevcral inftances of the .rnoft part of
the mefcnteric glands being coniiderably tumefied,
without either interrupting the tranfmifiion of fluids
to the blood- veiTels, or occasioning any dropfy.

An hydropic fwelling, indeed, feems often to affect
the arm fYou* a tumour of the axillary glancl : but ic
feems to me doubtful, whether the tumour of the atm.
may not be owing to fome eompreffioh of the axilla-
ry vein, rather thari to an obitruction of the lympha-
tics, t

MDCLXVI.

A particular interruption of abforption may be fup-
poied to take place in the brain. As no lymphatic
veflel's have yet very certainly been difcovere'd in that
organ, it may be thought, that the abforption, which
certainly takes place there, is performed by the extre-
mities of veins, or by veffels that carry the fluid di-
rectly into the veins ; fo that any impediment to the
free motion of the blood in the veins or the brain,
may interrupt the abforption there, and occaiion that
accumulation of ferous fluid which fo frequently oc-
curs from, a congeftion of blood in thefe veins. But
I give all this as a matter of conjecture only.
MDCLXVII.

Having thus explained the general caufes of drop-
fy, I ihould proceed, in the next place, to mention the
ieveral paits of the body in which ferous collections
take place, and fo to mark the diiFerent fpecies of
dropfy : but I do not think it neceifary for me to en-
ter into any minute detail upon this fubjed. In ma-
ny cafes thefe collections are not to be afcertained by
any external fymptoms, and therefore cannot be the
bbjecls of practice ; and many of them, though in
fome meafure difcernible, do not feem to be curable

VOL. .II. T t by

33* PRACTICE

by our art. I the more efpecially avoid mentioi
very particularly the fpecies, becaufe that has already
been fufficiently done by Dr. D. Monro, and other
writers, in every body's hands. I muft confine my-
felf here to the confideration of thofe fpecies which are
the mod frequently occurring and the.moft common
objects of our practice; which are, the Anaforca,
Hydrothorax, and Afcites ; and each of thefe I fhall
treat in fo many feparate fectioiis.

SECT. I.

OF A N A S A R C A,

MDCLXVIII.

THE Anafarca is a fwelling upon the furface of the
body, at firft commonly appearing in particular part*
only, but at length frequently appearing over the
whole. So far as it extends, it is an uniform fwelling
over the whole member, at firft always fofc, and rea-
dily receiving the preiTure of the finger, which forms
a hollow that remains for fome little time after the
prefFure is removed, but at length rifes again to its
former fulnefs. This fwelling generally appears, firft,
upon the lower extremities ; and there too only in the
evening, difapp earing again in the morning. It is
ufually more confiderable as the perfon has been
more in an erect pofture during the day ; but there
are many inflances of the exercife of walking prevent-
ing altogether its otherwife ufual coming on. Al-
though this fwelling appears at firft only upon the feet
and about the ankles ; yet if the caufes producing it
continue to act? it gradually extends upwards5 occu-
pying

OF PHYSIC. 331

pying the legs, thighs, and trunk of the body, and
fome times even the head. Commonly the (welling of
the lower extremities diminimes during the night;
and in the morning, the fwelling of the face is moft
conliderable, which again generally difappears aimoft
entirely in the courfe of the day.
MDCLXIX.

The terms 'of Anafarca and Leucophkgmatia have
been commonly contidered as fynonimous ; but fome
authors have propofed to confider them as denoting
didinct difeafes. The authors who are of this laft
opinion employ the name of Anafarca for -that difeafe
which begins in the lower extremities, and is from
thence gradually extended upwards in the manner I
have juft now defcribed ; while they term Leucophleg-
inatia-) that in which the fame kind of fweliing appears
even- at firft very generally over the whole body.
They feemto think alfo, that the two difcafes proceed
from different caufes ; and that, while the anafarca
may arife from the feveral caufes in MDCXLVIU. — M-
DCLIX. the leucophlegmatia proceeds efpecially from
a deficiency of red blood, as we have mentioned in M-
DCLX. et feq. I cannot, however, find any proper
foundation for this diftinclion. For although in drop-
lies proceeding from the caufes mentioned m MDCLX,
et feq. the difeafe appears in fome cafes more immedi-
ately affecting the whole body ; yet that does not eftu-
bliih a difference from the cmnmon cafe of anafarca :
for the difeafe, in all its circum (lances, comes at length
TO be entirely the fame ; and in cafes occaiioned by a
deficiency of red blood, I have frequently obferved it
to come on exactly in the manner of an anaiarca> as
above defcribed.

MDCLXX.

An anafarca is evidently a preternatural called! m
of ferous fluid in the cellular texture immediately un-
der the fkin. Sometimes pervading the ikin iciclf, it

T t 2 oozes

332 PRACTICE

oozes out through the pores of the cuticle; and feme-
times, too grofs to pafs by thefe, it raifes the cuticle in
bliftcrs. Sometimes the fkin, not allowing, the water
to pervade it, is compreffed and hardened, and at the
fame time Co much diftended,or to give anafarcous tu-
mours an unufual firmnefs. It is in thcfe laft circum-
ilances alfo that an erythematic inflammation is ready
to come upon anafarcous fwellings.
MDCLXX1.

An anafarca may immediately arife from any of the
feveral caufes of droply which acl more generally up-
on the fyfiem : and even when other fpecies of dropfy
jfrom particular circumilances, appear firft ; yet when-
ever thefe proceed from any caufes more generally af-
fecting the fyftem, an anarfaca fooner or later comes
alwavs to be joined with them.

MDGLXXII.

The manner in which this difeafe commonly • firft
appears, will be readily explained by what I have fa id.
in MDCL. refpecling the efFccls of the pofhtre of tiie
body. Its gradual progrefs, and its affecting, aft en
f ~>me time, not only the cellular texture under the fkin,
but probably alfo much of the fame texture in the in-
ternal parts, will be underitood partly from the com-
munication that is readily made between the fcveral
parts of the cellular texture; but efpecially from the
fame general caufes of the difeife producing their ef-
fects in every p;irt of the body. It appears to me,
that the water of anafarcous fwellings is more readily
communicated to the cavity of the thorax, and to the
lungs, than to the cavity of the abdomen, or to the
vifcera contained in it,

MDCLXXIII.

An anafarca is almoft always attended with a fcarci-

. ty of urine ; and the urine voided, is, from its fcarci-

ty always of a high colour ; and from die fame caufe,

alter cooling, readily lets fall a copious reddiih fedi-

O 1' ? H Y S I C. 333

ment. This fcarciry of urine may fometinves be ow-
ing to an obft ruction of the kidneys ; but probably is.
generally occaiioned by the watery parts of the blood
running off into the cellular texture, and being
thereby prevented from pafiing in the ufual quantity to
the kidneys.

The difeafe is dfo generally attended with r_n unu-
fual degree of thh'ii ; a circlirriftance I would attribute
to a like abftracticn of fluid from the tongue and fauces,
which are extremely .feniible tu every diminution of
the fluids in thefe parts.

MDCLXXIV.

The cure of anafarca is to be attempted up m tkree
general indications.

1. The removing the remote caufes of" the diftafc.

2. The evacuation of the fcrous fluid already col-
lected in the cellular texture.

3. The reftoring the tone of the fyftem, the lofs of
which may be confidered in many cafes as the proxi-
mate catife of the diieafe.

MDCLXXV.

The remote caufes are very often fuch ns had not
only been applied, but had been removed* long 'be-
fore the difeafe came on. Although, therefore, their
effects remain, the caufes themfelves cannot be the
objects of practice ; but if the caufes iliii continue to
be applied, fuch as intemperance, indolence, and ibm.e
others, they mull be removed. For the moil part,
tne remote ciules are ceria'ri difcafcs previous to the
cropfy, which are to be cured by the remedies parti-
cularly adapted to them, and cannot be treated of
bere. The curing of thefe, indeed, may be often dif-
ficult ; but it was proper to lay down the prefent in-
dication, in order to ihow, that when thefe remote

caufes

* Thrfe arc l.'rcje evacuations of different kin^s, b'.n efp^ci^ji/
bemorrhagies, which HHVX ceafcd beloic the ciropiy came on,

334

PRACTICE

caufes cannot be removed, the cure of the dropfy
muft be difficult, or perhaps impoffible. In many
cafes, therefore, the following indications will be to
little purpofe ; and particularly, that often the execu-
tion of the fecond will not only give the patient a
great deal of fruitlefs trouble, but commonly alfo hur-
ry on his fate.

MDCLXXVL

The fecond indication for evacuating the collected
ferum, may be fomedmes executed with advantage,
and often, at leaft, with temporary relief. It may be
performed in two ways. Firil, by drawing off the
water directly from the dropfical part, by openings
made into it for that purpofe : Or, fecoridly, by ex-
citmg certain ferous excretions ; in confequence of
which, an abforption maybe excited in the dropfical
parts, and thereby the ferum abforbed and carried into,
the blood- veiTels may afterwards be directed to run
out, or may fpontaneoufly pafs out, by one or other of
the common excretions.

MDCLXXV1I.

In an anafarca, the openings into the dropfical part
are commonly to be made in fome part of the lower
exiremeties ; and will be mod properly made by ma-
ny fmall punctures reaching the cellular texture. For-
merly, considerable incifions were employed for this
purpofe : but as any wound made in dropfical parts,
which, in order to their healing, mull necefTarily in-
flame and fuppurate, are liable* to become gangre-
nous ; fo it is found to be much fafer to make the open-.
ings by fmall punctures only, which may heal up by
the firft intention. At the fame time, even with re-
fpect to thefe punctures, it is proper to obferve, that
they mould be made at fome diftance from one another,

and

* Peculiarly liable in this difeafe on account of the dimi'nifhcd
tone and confequently the diminifbed Ibrength of the parts.

OF PHYSIC. 335

and that care fhould be taken to avoid making them
in the moft depending parts.

MDCLXXVIIL

The water of anafarcous limbs may be fometimes
drawn off by pea-ifliies, made by cauftic a little below
the knees : for as the great fuelling of the lower ex-
tremities is chiefly occafioned by the ferous fluid ex-
haled into the upper parts conftantly falling down to
the lower; fo theiffuesnow mentioned, by evacuating
the water from thefe upper parts, may very much relieve
the whole of the difeafe. Unlefs, however, the ifiues be
put in before the difeafe is far advanced, and before
the parts have very much loll their tone, the places
of the iffues are ready to become affected with gan-

grene.

Some practical writers have advifed the employ-
ment of fetons, for the fame purpofe that I have
propofed iffues ; but I apprehend, that fetons will
be more liable than iflues to the accident juft now
mentioned.

MDCLXXIX.

For the purpofe of drawing out ferum from anafar-
cous limbs, blifters have been applied to them, and
fometimes with great fuccefs; but the bliftered parts are
ready to have a gangrene come upon them. Bliftering
is therefore to be employed with great caution; and
perhaps only in the circumilances that I have mention-
ed above to be fit for the employment of iflues.
MpCLXXX.

Colewort-leaves applied to the (kin, readily occafiori
a watery exfudation from its furface ; and applied to
the feet and legs affected with anafarca, have fome-
times drawn off the water very copioufly, and with
great advantage.

Analogous, as I judge, to this, oiled filk-hofe put
upon the feet and legs, fo as to (hut out all communi-
cation with the external air, have been found fome-
times to draw a quantity of water from the pores of

the

330 PRACTICE

the {kin, and are fa id in this way to have relieved and.*
farcous fwel tings; but in feveral trials made, I have
never fc-und either the application of thefe hole, or
that of the cule Wort-leaves, of much fervice.

MDCLXXXI.

^Thefetorid means propofed in MDCLXXVI. for draw-
ing off the water from dropiical places, may be the
employment of emetics, purgatives, diuretics, or fu-
dorifics*. •

MDCLXXXII.

As fpontaneous vomiting has fometimes excited an
abforption in hydropic parts, and thereby drawn off
the waters lodged in them, it is reasonable to fuppoie
that vomiting excited by art may have the fame effect ;
and accordingly it has been often praclifed with ad-
vanrage. The practice, however, requires that the
flrong antimonial emetics be employed, and that they
be repeated frequently after fhort intervals.
MbCLXXXIII.

Patients fubmit more readily to the ufe of .purga-
tives, than to that of emetics ; and indeed they com-
monly beas the former more eaiily than the latter.
At the fame time, there are no means we can employ
to procure a copious evacuation of ferous fluids with
greater certainty than the operation of purgatives, and
it is upon thefe accounts that purging is the evacuation
which has been moil: frequently, and perhaps with
moil fuccefs, employed in dropfy. It has been gene-
rally found neceflary to employ, purgatives of the more
drailic kind ; which are commonly known, and need
riot be enumerated here*. I believe, indeed, that

the

*. How does this lad agree with the firft fen fence of this aiiticle?

§ The Draitic purgatives are Jalap, Colocynth, Gamboge,
Scammony, &c. Their Drailic quality however depends very much
on the dole in which they are given, fmali dofes being gently laxa-
tive, while large ones are very violent in their operation. The/
ought Jeldom to be given alone, but in conjunction with fume aro--
ic, which grcuily increafcs tht-ir action, and at the fame lime

O F P H Y S I G. 33?

the more draftic purgatives arc the moft effectual for ex-
citing abforption, as their flimulus is mod readily com*
municated to the other parts of the fyftem ; but of late
an opinion has prevailed, that feme milder purgatives
may be employed with advantage. This opinion has
prevailed particularly with regard to rhe cryilals vul^
garly called the Cream of Tartar, which in large dof-
es, frequently repeated, have fometimes anfwered the
purpofe of exciting large evacuations both by ftool and
urine, and has thereby cured dropfies. This medi-
cine, however, has frequently failed, both in its opera-
VOL. II. Uu tion

prevents the uneafinefs of griping, with which their operation is fre-
quently attended : moft of thefe drafh'cs being refinous fubftances,
they are difficultly foluble in the alimentary canal, or if reduced to
a powder they are liable to concrete ; in either cafe their adlion is
impeded. To remedy thete inconveniencies, it is ufuul to add to*
them fame fait, which both divides the refin and prevents it's con-
cretion ; and confequently inct cafes it's aclion. For thefe reafons,
we find in the (hops many formula?, in which the draftic icfins are
mixed with either faits or aromatics, or both : As, the Pulvis Aloe-
ticus, Pulvis e Scammonio compofitus, Pulvis e Scammonio cum A-
Ice, Pulvis e fenna compoiitus, and Ele£luarium e Scammonio of the
Londen Pharmacopoeia; and, the Pulvis c Jalappa compofitns,Pulvi*
e Scammonio compofitus Pilulx Alceticse, Pilule ex colocynthide
cum Alee, Pilulae> e Jalappa, aod Pilulse Rufi of the Edinburgh
Pharmacopoeia.

Any of the foregoing compofitions, if given in fufficient dofes,
are very a&ive and bnfk purges. Many more naight be contrived,
and on fome occafions may be neceffary. For procuring a briik
difcharge of fluids, an addition of Calomel is remarkably efficacious
as in the following formula :
$,. Scaramon.

Calomel.

Crem. Tart.
- Zinzib a- a. p, oe.

M.f. Pulv.

The dofc of this powder is two fcruplcs or a drachm, it is extremely
active and ought to be ufed with care, the patients being kept mo-
derately warm, and drinking fome thin jnucilaginous liquor during
it'* operation.

33* PRACTICE

tion and effects, when the draftic purgatives Lav6 beei&
more fuccefsful.

Practitioners have long ago obferved, that, in the
employment of purgatives, it is requilitc they be re-
peated after as ilrort intervals as the patient can bear ;
probably for chis reafon* that when the purging is not
carried to the degree of loon exciting an abforption,
the evacuation weakens the fyftem, and thereby in-
creates the afflux of fluids to the hydropic parts.
MDCLXXXiV.

The kidneys afford a natural outlet for a great part
of the watery fluids contained in the blood- vetiHs ; and
the increasing the excretion by the kidneys to a conli-
derable degree, is a means as likely as any other of
exciting an abforption in drppfieal parts. It is upon
this account that diuretic medicines have been al-
ways properly employed in the cure of dropfy. The
various diuretics that rnay be employed, are enumerat-
ed in every treatifeof the Materia Mcdica and of the
Practice ot'Phyfic, and therefore need not be repeated
here. It happens, however, unluckily, that none of
them are of very certain operation ; neither is it well
known why they fometimes fucceed, and why they fo
often fail ; nor why one medicine mould prove of fer-
vice when another does not. It has been generally
the fault of writers upon the Praclice of Phyfic, that
they give us inllances of cafes in which certain medi-
cines have proved very efficacious, but neglect to
tell us in how many other inllances the fame have
failed.

MDCLXXXV.

It deferves to be particularly obferved here, that
there is hardly any diuretic more certainly powerful
than a large quantity of common water taken in by
drinking. I have indeed obferved above, in MDCLVIII.
that a large quantity of water, or of v»atery liquors,
taken in by drinking, has fometimes proved a caufe of

dropfy ;

O F P H Y S I C, 33

4iOpfy; and practitioners have been formerly fo much
afraid that watery liquors taken in by drinking might
run off into the dropiical places and increafe the uif-
eafe, that they have generally enjoined the abftaining,
as much as poflible, from fuch liquors. Nay, it has
been further averted, that by avoiding this fupply of
exhalation, and by a total abftinence from drink, drcpiies
have been entirely cured. What concluiion is to be
drawn from thefe facts, is however, very d .ubtful.
A dropfy arifing from a large quantity of liquids taken
into the body, has been a very rare occurrence ; and
there are, on the other hand, innumerable inflances of
very large quantities of water having been taken in and
running off again very quickly by ftool and urine,
ivithour producing any degree of dropfy. With refpect
to the total ab.ftinence from drink, it is a practice of
the moil difficult execution ; and therefore has been
fo feldom practiied, that \ve cannot poflibly know how
far it might prove effectual. The practice of giv-
ing drink very fparingly, has indeed been often em-
ployed : but in a hundred inflances I have feen it car-
ried to a great length- without any manifefl advantage;
while, on the contrary, the practice of giving drink
very largely has been found not only fafe, but very of-
ten effectual in curing the difeafe. The ingenious and
learned Dr. Milhnan has, in my opinion, be^n com-
mendably employed in reitoting the piactice of giv-
ing large quantities of watery liquors for the cure of
dropfy. N Jt only from the inftances he mentions from
his own practice, and from that of feveral eminent
j)hyficians in other parts of Europe, but alfo from
many inflances in the records of phyiic, of the good
effects of drinking large quantities of mineral waters
in the cure of dropfy, I can have no doubt of the
practice recommended by Dr. Mill man being very of-
ten extremely proper. '1 apprehend it to be efpccial-
]y adapted to thofe cafes in which the cure is chiefly

U u 2 at_

'

343

PRACTICE

attempted by diuretics. It is very probable that thefe
medicines can hardly be carried in any quantity to
the kidneys without being accompanied with a large
portion of water; and the late frequent employment
of the cryftals of tartar has often mown, that the diu-
retic effects of that medicine are almoft only remarka-
ble when accompanied with a large quantity of water ;
and that without this, the diuretic effects of the medi-
cine feldom appear. I mail conclude this fubject with
obferving, that as there are fo many cafes of d-ropfy
abfolutely incurable, the practice now under coniide-
ration may often fail, yet in moft cafes it may be fafe-
ly tried ; and if it appear that the water taken in p^ffcs
readily by the urinary fecretion, and efpecia%T that in
increafes the urine beyond the quantity of drink taken
in, the practice may probably be continued with
great advantage : but, on the contrary, if the urine be
not increafed, or be not even in proportion to the
drink taken in, it may be concluded, that the water
thrown in runs off by the exhalants, and will augment
the difeafe.

MDCLXXXVI.

Another fet of remedies which may be employed
for exciting a ferous excretion, and thereby curing
dropfy, is that of fud'orifics. Such remedies, indeed,
have -been fometimes employed; but however ufeful
they may have been thought, there are few accounts
of their having effected a cure ; and although I have
had iorne examples of their fuccefs, in moil instances
of their trial they have been ineffectual.

Upon this fubject it is proper to take notice of the
feveral means that have been propofed and employed
fur diffipating the humidity of the body ; and parti-
cularly that of heat externally applied to the furface
t. Of fuch applications I have had no experience ;
their propriety and utility muft reft upon the crr-
ah :;f the authors who relate them. I fhallofier only

this

OF PHY S I C. 341

this conjedhire upon the fubjecl : That if fuch mea-
fares have been truly ufeful, as.it has feldom been by
the drawing out of any fenfible humidity, it has pro-
bably been by their reftoring the perforation, which
is fo often greatly diminifhed in this difeafe ; or, per-
haps, by changing the flate of the ikin, from the im-
bibing condition which is ^Hedged to take place, inro
that of perfpiring.

MDCLXXXVII.

When, by the feverai means now mentioned, we
fhall have fucceeded in evacuating the water of drop-
lies, there will then cfpccially be occafion for our third
indication ; which is, to reilore the tone of the fyftem,
the lofs of which is fo often the caufe of the difeafe,
This indication, indeed, may properly have place
from the very firft appearance of the difeafe ; and cer-
tain meafures adapted to this purpofe may, upon fuch
firft appearance, be employed with advantage. In
many cafes of a moderate difcafe, I am perfuaded that
they may obviate any future increafeof it.
1V3DCLXXXVIII.

Thus, upon what is commonly the fir(t fymptoms
of anafarca, that is, upon the appearance of what are
called Oedematous Swellings of the feet and legs, the
three remedies of bandaging, friction, and exercife,
have often been ufed with advantage. •
MDCLXXXIX.

That fornc degree of external compreflion is fulted
to fupport the tone of the veffds, and particularly to
prevent the effects of the weight of the blood in dilat-
ing thofe of the lower extremities, muft be fufficiemly
evident ; and the giving that compreffionby a bandage
properly applied, has been often ufeful. In apply-
ing fuch a bandage, care is to be taken that the com-
preflion may never be greater on the upper than on
the lower part of the limb ; and this, 1 think, can hard-

342 PRACTICE

ly ever be fo certainly avoided, as by employing a.
properly conftructed laced flocking.
MDCXC.

Friction is another means by which the action of
the blood- veiTels may be promoted, and thereby
the ilagnation of fluids in their extremities prevented.
Accordingly, theufe of the flefh-brufh has often con-
tributed to difcufs cedematous fwellings. It appears
to me, thai: friction, for the purpofes now' mentioned,
is more properly employed in the morning, when the
Dwelling is very much gone olf, than in the evening,
when any coniiderable degree of it has already 'come
on. I apprehend alib, that friction being made from
below upwards only, is more ufeful than when made
alternately upwards and downwards. It has been
common, inftcad uf employing the tleih-brufh, to
make n j fii£tion by warm and dry flannels ; and this
may in iome c*ies be the mod convenient : but I can--
not perceive that the impregnation of thcfe flannels
with certain dry fumes is of any benefit.
MDCXCI.

With refpecc to exercife, I mtifl obferve, that al-
though perfons being much in an erect pofture during
the day, may feem to incrcale the fuelling which
comes on at night; yet as the action of the mufcles
has a great ihare in promoting the motion of the ve-
nous blood, fo I am certain, that as much exercife in
walking as the patient can eafily bear, will often pre-
vent that cederr.atous fwclling, which much Handing^
and even fitting, would have brought on.
MDCXCII.

Thefe meafures, however, although they may be
ufeful at the coming on of a dropfy, whofe caufes are
not very powerful, will be often infufficient in a more
violent difeafe ; and fuch therefore will require more
powerful remedies. Thefe are, exercife and tonic
medicines; which may be employed both during the

courie

OF PHYSIC. 343

of the difeafe and efpecially after the water has
been evacuated.

MDCXCIIL

Exercife is Alfred to affift in every function of the ani-
mal oeconomy> particularly to promote perfpirationy
and thereby prevent the accumulation of watery flu-
ids in the body. I apprehend alfo, that it may be the
moft effectual means for preventing the fkin from be-
ing in an imbibing ftatc; and, as has been hinted a-
bove on the fubject of Emaciation (MDCVII.) I airr per-
fuaded, that a full and large perforation will always
be a means of exciting abforption in every part of the
fyftem. Exercife, therefore, promifes to be highly
tifeful in dropfy ; and any mode of it may be employ-
ed that the patient can moft conveniently admit of. It
iliould, however, always be as much as he can eaiily
bear : and in anafarca, the fhare which the exercife of
mufcles has in promoting the motion of the venous
blood, induces me to think that bodily exercife, to
whatever degree the patient can bear it, will always
be the moft ufeful. From fome experience alfo, I am:
perfuaded, that by exercife aloner employed early in
the difeafe, many dropfies may be cured.
MDCXCIV.

Befides exercife, various tonic remedies are properly
employed to reftore the tone of the fyflem. The
chief of thefe are, chalybcates, the Peruvian bark, and
various bitters. Thefe are not only faked to reftore
the tone of the fyftem in general, but are particularly
ufeful in ftrengthening the organs of digeftlon, which
in .dropfies are frequently very much weakened ; and
for the fame purpofe alfo aromatics may be frequently
joined with the tonics.

MDCXCV.

Cold bathing is upon many occafions the moft pow-
erful tonic we can employ ; but at the beginning of
diopfy,- when the debility of the fyftem is confiderable,

it

344 PRACTICE

it can hardly be attempted with fafety. After, li
ever, the water of dropfies has beenvery fully evacuat-
ed, and the indication is to ftrengthen the fyftem for
preventing a relapfe, cold bathing may perhaps have a
place.. It is, at the fame time, to be admitted with
caution ; and can fcarcely be employed till the fyftem
has other wife recovered a good deal of vigour. When
that indeed has happened, cold bathing may be very
ufeful in confirming and completing it.

MDCXCVI.

In perfons recovering from dropfy, while the feve-
ral means now mentioned for ftrengthening the fyftem
arc employed, it will be proper at the fame time to
keep conftantly in view the fupport of the watery ex-
cretions ; and confequently the keeping up the per-
fpiration by a great deal of exercife, and continuing
the full flow of the urinary excretion by the frequent
ufe of diuretics.

SECT. II.

OF THE HYDROTHORAX OR DROPSY OF
THE BREAST.

MDCXCVII.

THE preternatural collection of ferous fluid in the
thorax, to which we give the appellation of Hyurotbo-
rax<, occurs more frequently than has been imagined*
Its prefence, however, is not always to be very cer-
tainly known ; and it often takes place to a confident-
b]e degree before it be difcovered.
MDCXCVIIL

Thefe collections of v/atery fluids in the thorax, arc

found-

b F PHYSIC, 345

folind in different fituations. Very often the water
is found at the fame time in both facs of the pleura,
but frequently in one of them only. Sometimes it is
found in the pericardium alone ; but for the moil part
it only appears there when at the fame time a collec-
tion is prefent in one or both cavities of the thorax.
In fome inilances, the collection is found to be only
in that cellular texture of the lungs which furrounds
the branchiae, without there being at the fame time
any effuiion into the cavity of the thorax.

Pretty frequently the water collected confifts chief-
ly of a great number of hy datides in different lituati-
6ns ; fometimes feemingly floating into the cavity, but
frequently connected with and attached to particular
parts of che internal furface of the pleura.
MDCXCIX.

From the collection of water being thus in various
fituations and circumttances, fymptoms arife which
are different in different cafes ; and from thence it be-
comes often difficult to afcertain the prefence and na-
ture of the affection. I mail, however, endeavour
here to point out the moft common fymptoms, and
efpecially thofe of that principal and moil frequent
form of the difeafe, when the ferous fluid is prefent in
both facs of the pleura, or, as we ufually ipeak, in
both cavities of the thorax.

MDCC.

The difeafe frequently comes on with a fenfe of anx-
iety about the lower part of the ftcrnum. This, be-
fore it has fubiiited long, comes to be joined with
fome difficulty of breathing ; which at firft appears on-
ly upon the perfon's moving a little fader than ufual,
upon his walking up an activity, or upon his afcend-
ing a ilair-cafe : but after fome time, this difficulty of
breathing becomes more conitant and confiderable,
efpecially during the night, when the body is in a
horizontal iituation. Commonly, at the fame time,

VOL. II. X x

PRACTICE

lying upan one fide is more eafy than upon the
or perhaps lying upon the back more eafy than upon
either fide. Thefe circum (lances are ufually attended
with a frequent cough, that is at firft dry; but which,
ar'ter fome time, is accompanied with an expectoration
of thin mucus.

With all thefe fymptoms, the hydrothorax is not
certainly difcovered, as the fame fymptoms often at-
tend other difeafes of the bread. When, however,
along with thefe fymptoms, there is at the fame time
an cedematous f welling of the feet and legs, a leuco-
phlegmatic palenefs of the face, and a fcarcity of urine^
the exiftence of a hydrothorax can be no longer
doubtful. Some writers have told us, that fometimes
in this difeafe, before the f welling' of the feet comes
on, a watery f welling of the fcrotum appears : but I
have never met any inftance of this.

MDCCI.

Whilft the prefence of the difeafe is fomewhat un-
certain, there is a fymptom which fometimes takes
place, and has been thought to be a certain character-
iftic of ic ; and that is, when, foon after the patient has
fallen afleep, he is fuddenly awaked with a fenfe of
anxiety and difficult breathing, and with a violent
palpitation of the heart. Thefe feelings immediately
require an erect poliure ; and very often the difficulty
of breathing continues to require and to prevent fleep
for a great part of the night. This fymptom I have
frequently found attending the difeafe ; but I have
alfo met with feveral inftances in which this fymptom
did not appear. I mud remark further, that I have
not found this fymptom attending the empyema, or
any other difeafe of the thorax ; and therefore, when
it attends a difficulty of breathing, accompanied with
any the f mailed fydem of dropfy, I have had no doubt
in concluding the prefence of water in the cheft, and

have

OF PHYSIC. 347

have always had my judgmen/ confirmed by the fymp-
toms which afterwards appeared.
MDCCIL

The hydrothorax often occurs with very few, of
almofl none, of the fymptoms above mentioned ; and
is not, therefore, very certainly difcovered till fome
others appear. The mod decifive iymptom is a fluc-
tuation of water in the ched, perceived by the pati-
ent hinifelf, or by thephyfician, upon certain motions
of the body. How far the method propofed by Auen-
brugger will apply to afcertain the prefence of water
and the quantity of it in the cheft, I have not had oc-
cafion or opportunity to obferve.

It has be~n faid, ihat in this difeafe fome tumour ap-.
pears upon the iides or upon the back ; but I have not
met with any iaitance of this. In one indance of the
ijifeafe, I found one fide of the thorax confiderably en*
larged, the ribs (landing out farther on that iide than
upon the other.

A numbnefs and a degree of palfy in one or both
arms, has been frequently obferved to attend a hydro*
thorax.

Soon after this difeafe has made fome .progrefs, the
pulfe commonly becomes irregular, and frequently
intermitting: but this happens in fo many other dif«
eafes of the bread, that, unlefs when.it is attended with
iome other of the above mentioned fymptoms, it can-
not be conildered as denoting the hydrothorax.
MDCCIII.

This difeafe, as. other droplks, is commonly attend-
ed vvirh third and a fcarcity of unne, to be explained
in the fame manner as in the cafe of anafarca (MDC-
LXXIII.) The hydrothorax, however, is form-times
without third, or any other febrile fyaiptom ; although
I believe this happens in the cafe of partial affections
only, or when a more general aff?£tion is yet but in a
flight degree. In both cafes, however, and more efpe*

X x 2 cially

348 P R A C T I C E

cially when the difeafe is confiderably advanced,
degree of fever is generally prefent : and I apprehend
it to be in luch cafe, that the perfons affeded are
more than ufually fenfible to col 1, and complain of
the coldnefs of the air when that is not perceived by
other perfons.

MDCCIV.

The hydrothorax fome times appears alone, with-
out any other fpecies of dropfy being prefent at the
fame time : and in this cafe the difeafe, for the moft
part, is a partial affection, as being either of one fide
of the thorax only, or being a collection of hydatides
in one part of the cheft. The hydrothorax, however,
is very often a part of more univerfal dropfy, and when
at the fame time there is water in all the three princi-
pal cavities and in the cellular texture of a great part
of the body. I have met with feveral inftances, in
which fuch univerfal dropfy began firft by an effufion
into the thorax. The hydrothorax, rjowever, more
frequently comes on from an anafarca gradually in-
creafins;; and, as I have faid above, the general dia-
thefis feems often to affect the thorax fooner than it
does either the head or the abdomen,
MDCCV:

This difeafe feldom admits of a cure, or even of alle-
viation, from remedies. It commonly proceeds to,
give more and more difficulty of breathing, till the
action of the lungs be entirely interrupted by the
quantity of water effufed ; and the fatal event fre-
quently happens more fuddenly than was expe&ed. — •
In many of the inftances of a fatal hydrothorax, I have
remarked a fpitting of blood to come on feveral days
before the patient died.

MDCCVI.

The raufe of hydrothorax is often manifeflly one or
other of the general caufes of dropfy pointed out p.-
toove : but what it is that determines thefe general

caufes

OF PHYSIC. 349

eaufes to aft more efpecially in the thorax, and parti-
cularly what it is that produces the partial collections
that occur there, I do not find to beeafily aicertained.

MDCCVII.

From what has been faid above, it will be evident,
that the cure of hydrothorax muft be very much the
fame with that of anafarca ; and when the former is
joined with the latter as an effect of the fame general
diathelis, there can be no doubt of the method of cure
being the fame in boch. Even when the hydrotho-
rax is alone, and the difeafe partial, from particular
caufes acting in the thorax only, there can hardly be
any other meafures employed, than the general ones
propofed above. There is only one particular mea-
lurc adapted to the hydro thorax ; and that is, the
drawing off the accumulated waters by a paracenteiis of
the thorax.

MDCCVlli.

To what cafes this operation may be moft properly
adapted, I find it difficult to determine. That it may
be executed with fafety, there is no doubt ; and that
it has been fometimes praftifed with fuccefs, fcems to
be very well vouched*. When the difeafe depends

upon
i

* In the memoirs of the Academy of Sciences at Paris, for 1703.
M . Du Verney relates the cafe of a woman who had both an Af •
cites and Hydrothorax. Ke firft emptied the abdomen by tap-
ping, and a few days afterwards, he pierced the thorax with a tro-
char, near to the fpine, between thefeconei and third falfe ribs ; by
which opening he drew off a confiderable quantity of water ; the o-
peration gave immediate relief to the patient, and (he was able to
return to her ordinary employments in about a month's time.

Bianchi auo relates a fuccefsful operation of tapping the thorax ;
but he feems to be timid in his practice, and confefTes that he has
feldom ventureu on the operation.

The practice ef evacuating water contained in the thorax by an
inciiion is very old. We find it reoommended by Hippocrates,
with particular directions for performing the operation, in his fecond
book orrdifeafes. See the Geneva Edition ofFoefius'a Hippocrates,
pg-483-

35® PRACTICE

upon a general hydropic diathefis, it cannot alone
prove a cure, but may give a temporary relief ; and
when other remedies feern to he employed wirh advan^
tage, the drawing off the water may very much fa-
vour a complete cure. I have not, however, been fo
fortunate as to fee it practifed with any fuccefs ; and
even where it was moil promifing, that is, in cafes of
partial affection, my expectations have been difappomt-
ed from it.

SECT. Ill,

OF ASCITES, OR DROPSY OF THE LOWER

BELLY.

MDCCIX.

Tim name of Afcites is given to every collection of
\vaters caufing a general fwelling and diftenfion of the
lower belly : and fuch collections are more frequent
than, thofe which happen in the thorax.
MDCCX,

The collections in the lower belly, like thofe of the
thorax, are found in different fituations. Moft com-
monly they are in thefac of the peritonaeum, or gene-
ral cavity of the abdomen : but they often begin by
facs formed upon, and connected with, one or other

of

That the pra&ice was frequently attended with fuccef?, in thofe
early ages, is fufficiently evident by the context ; for Hippocrates,
after defcribing the operation, and the fubfequent management of
the patient fays, " If pus appear on the plaiiler covering the wound;
" on the fifth .day after the operation, the patient generally reco-
*' vers j if not, he is feized with a cough and thirft, and dies."

0 F P H Y S 1 C. 351

of the vifcera ; and perhaps the moil frequent in-
ilances of this kind occur in the ovaria of females.
Sometimes the water of afcites is found entirely with-
out the peritonaeum, and between this and the abdomi-
nal mufcles,

MDCCXI.

Thefe collections connected with particular vifcera,
and thofe formed without the peritonaeum, form that
difeafe which authors have temied the encyfled dropfy,
or hydrops faccatus. Their precife feat, and even
their exiitence, is very often difficult to be afcertain-
ed. They are generally formed by collections of hy-
datides.

MDGCXII.

In the mofl ordinary cafe, that of abdominal drop-
fy, the fuelling at firft is in lome meafure over the
whole belly, but generally appears moil confiderable
in the epigafhium. As the difeafe, however, advanc-
es, the f .veiling becomes more uniform over the whole.
The diftenfion and fenfe of weight, though confider-
able, vary a liiue according as the poilure of the body
is changed ; the weight being felt the moft upon the
lideon which the patient lies, while at the fame time
on the oppoiite fide the difleniion becomes fomewhat
lei's. In almcft all the inftances of afcites, the fluctu-
ation of the water within, may be perceived by the
practitioner's, feeling, and fometimes by his hearing.
This perception of fluctuation does not certainly dif-
tingiiiih the different ftates of dropiy ; but ferves very
well to diftinguim dropfy from tympanites, from cufes
of phyfconia, and from the ftate of pregnancy in
women.

MDCCX1II.

As afcites frequently occurs when no other fpeci s
of dropfy does at the fame time appear ; but fome-
times the afcites is a part only or' univerfal dropiy.
In this cafe, it ufually comes on in confequence of \\\\

a 11: i-

35* P R A C T 1C E

anafurca, gradually increafing ; but its being joined
with anafarca, does not always denote any general dia-
theiis, us for the rnoft part an afcites fooner or later oc-
caiions cedeniatous f \veilings of the lower extremities.
When the collection of water in the abdomen, from
whatever caufe, becomes confidenible, it is always at-
tended with a difficulty of breathing ; but this fymp-
tom occurs often when, at the fame time, there is no
water in the thorax. The afcites is fometimes unac-
companied with any fever ; but frequently there is
more or lei's of fever preient with it. The difeafe is
never coniiderablc, without being attended with thirlt
and fcarcity of urine.

MDCCXIV.

In the diagnoils of afcites, the greatefl difficulty that
occurs, is in difcerning when the water is in the cavity
of the abdomen, or when it is in the different dates of
encyited dropfy above mentioned. There is, perhaps,
no certain means of afcertaining this in all cafes ; but
in many we may attempt to form fome judgment with
regard to it.

When the antecedent circumftances give fufpicion
of a general hydropic diathefis ; when at the fame
time forne degree of dropfy appears in other parts of
the body ; and when, from its firfl appearance, the'
fwelling has been equally over the whole belly, we may
generally prefume that the water is in the cavity of
the abdomen. But when an afcites has not been pre-
ceded by any remarkable cacheclic ftateof the fyftem,
and when at its beginning the tumour and tenlion had
appeared in one part of the belly more than ano-
ther, there is reafon to fufpecl an encyfted dropfy.
Even when the teniion and tumour of the belly have
become general and uniform over the whole ; yet if
the fy item of the body in general appear to be little
afleded ; if the patient's ftrength be little impaired ;
if the appetite continue pretty en-tire, and the natural

fleep

u F PHYSIC. 353

Ikep be little interrupted ; it*, the rnenfes in females
continue to ilovv as' ufual; if there be yet no anafarca ;
or, though it may lave already uken place, if it be
ftill confined to the lower extremities, and there be 110
leucophlegmatic palenels or tallow colour in the coun-
ionance; if there be no icvvr, nor ib much third, 01*
fcarcity of urine, as occur in ;i more general afieclion;
then, according as more of thefe diilcrenc circiumianc-
es take place, there will be the ftronger ground for
fuppofing the afcites to be of the encyfled kind.

The chief exception to be made from this as a gene-
ral rule, will, in iny opinion, be when the afcites may
with much probability, be prefumed to, have come ou
in confequence of a fcirrhous. liver*; which, I appre-
hend, mayoccafion a collection of water in the cavity
of the abdomen, while the general fyftem of the body
may not be otherwife much atlecled.

MDCCXV.

With refpe£t to the cure of afcites when of the en-
cyfled kind, it does not, fo far as I know, admit of
any. When the collection of water is in the abdomi-
nal cavity alone, without any other fpecies of ciropfy
pTefent at the fame time, I apprehend the afcites will
always be of 'difficult cure ; for it may be prefumed to
depend upon a fcirrhofity of the liver, or other confi-
derable affe&ion of the abdominal vifcera, which. I
conceive to be of very difficult cure, and therefore
the afcites depending upon them. At the fame time,
iuch cafes may often admit of a temporary relict
the paracenteiis.

MDCCXVI

When the afcites is a part of. univerfal dropfy, it
in ay, as far as other cafes of that kind can, admit of a
cure; and it will be obvious, that fuch u cure mail be
6Dta.med by the fame means as above propoied for the
cure of general aiiaiarca*.

It frequently happens that the afcices is attend e:i
VOL. II. Y y with

* See the notes on Article 1683,

354 PRACTICE

with a diarrhoea ; and,. in that cafe, does not admit of
the ufe of purgatives' fo freely as cafes of anafarca
commonly do. It is therefore often to be treated by
diuretics almoft alone.

The diuretics that may be employed, are chiefly
thofe above-mentioned ; but in afcites, a peculiar one
has been found out. It is a long-continued gentle
fridion of the ikin over the whole of the abdomen,
by the fingers dipped in oil. This has fometimes been
ufeful in exciting an increafed flow of urine ; but in
mod of the trials of it which I have known made, it
has failed in producing that effect.
MDCCXVII.

The afcites admits of a particular means for imme-
diately drawing off the collected waters : and that is
the well-known operation of the paracentefis of the
abdomen. In what circumftances of aicites this ope-
ration can mo ft properly be propofed, it is difficult to
determine ; but, fo far as I can judge, it. muil be re-
gulated by very much the fame considerations as thofe
above-mentioned with regard to the paracentefis of
the thorax.

The manner of performing the paracentefis of the
abdomen, and the precautions to be taken with refpect
to it, are now-fo commonly known, and delivered in
fo many books, that it is altogether unneceffary for
me to offer any directions upon that fubject here ;
efpecially after the full and judicious information and
directions given by Mr. BELL, in the fecond volume
of his Syjletn of Surgery.

OF P H Y S I C, 355

CHAP. IV.

OF GENERAL SWELLINGS, ARISING FROM
AN INCREASED BULK OF THE WHOLE
SUBSTANCE OF PARTICULAR PARTS.

MDCCXVIII.

UPON the fubjecb of this chapter, feveral nofolo-
gical difficulties occur, and particularly with re-
fpecl: to admitting the Pbyfionia into the order of Ge-
neral Swellings. At p: vever, it is not necef-
fary for me to difcufs this point, as I am here to omit
entirely the conflderatipn of Pbyfconia; both becaufe
it can feldom admit of any fuccefsful pra&ice, and
bccaufe I cannot deliver any thing uleful either
with regard to the pathology or practice in fuch a difr
cafe.

MDCCXIX.

The only-other genus of difeafe comprehended un-
der the title oi the prefent chapter, is the Rachitis ;
and this being both a proper example of the clafs of
Cachexy, and of the order of Intumefcentics or General
Swellings, I fhall offer fome observations with regard
to it.

OF RACHITIS, OR RICKETS.

MDCCXX.

THIS difeafe has been fuppofed to have appeared
only in modern times, and not above two hundred
years. This opinion, notwithftanding it has been
maintained by perfons of the moil refpeclable authori-
ty*, appears to me, from many coniiderations, impro-
bable j but it is a point of too little confequence to

Y y '2 detain

* Boerhaave was of this opinion, fee ..Van Swieten's commentary
en Aphorii'm 1482.

356 PRACTICE

fletain my readers here. The only application of u
which deferves any notice is, that it has led to a no-
tion of the difeafe having arifen from the lues venera,
which had certainly made its firft appearance in Eu-
rope not very long before the date commonly affigned
for the appearance of rachitis : but I ihali hereafter
{how, that the fuppofed connection between the Si-
phylis and Rachitis is without foundation*.

MDCCXXI.

In delivering the hiftory of the Rickets, I muft, in
the firft place, obferve, that with refpeci: to the ante-
cedents of the difeafe, everything to be found in au-
thors upon this fubjecl:, appears to me to reft upon a
very uncertain foundation. In particular with refpeci
to the ftate of the parents whole offspring become af-
fected with this difeafe, I have met with many inftan-
ces of it in children from feemingly healthy pa-
rents ; and have met likewife with many inttances
of children who never became affected with it, al-
though born of parents who according to the common
accounts, iliould have produced a rickety offspring :
fo that, even making allowance for the uncertainty of
fathers, I do not find the general opinion of authors
upon this fubjecl: to be properly fupportcd.

MDCCXXII.

The difeafe, however, may be juitly confidered as
proceeding from parents; for it often appears in a
great number of the fame family ; and my obfervation
leads me to judge, that it originates more frequently
from mothers than from fathers. So far as I can refer
the difeafe of the children to the ftate of the " parents j
it has appearrd to me moft commonly to arife from
icrne weaknefs, and pretty frequently from a fcrop.hu-
lous habit, in the mother. To conclude the fubjecT,
I mud remark, that in many cafes I have not been
able to difcem the condition of the parents, to which
I could refer it.

When
* See Article 1717.

OF PHYSIC. 357

When nurfes, other than the mothers, have bern
employed to fuckle children, it has been fuppofed that
fuch nurfes have frequently given occafion to the dif-
cafe* ; and when nurfes have both produced and have
fuckled children who became rickety, there may be
ground to fufpecl their having occaiioned the diieafe
in the children of other perfons : but I have had few
opportunities of afcertaining this matter. It has in
forne meafure appeared to me that thofe nurfes are moil:
likely to produce this difeafe, who give infants a large
quantity of very watery milk, and who continue to
fuckle them longer than the ufual time. Upon the
whole, however, I am of opinion, that hired nurfes fel-
,dom occafiori this difeafe., unlefs when a predifpofitiprt
to it has proceeded from the parents.

MDCGXXIIL

With regard to the other antecedents, which have
been ufually enumerated by authors as the remote
caufes of this difeafe, I judge the accounts given to be
extremely fallacious ; and I am very much per'Iuadcc!,
that the circumftanccs in the rearing of children, have
lefs efredl in producing rickets than has been imagin-
ed. It is indeed not unlikely, that fome of thefe cir-
cumftances mentioned as remote cauies may favour,
while other circumftances may refift, the coming on
of the difeafe ; but at the fame time, I doubt if any of
the former would produce it where there was no pre-
difpontion in the child's original conltitution. This
opinion of the rcmore caufes, I have formed from ob-
ferving, that the difeafe comes on when none of thefe
had been applied ; and more frequently that many or"
them had been applied without occaiioning the dif-
eafe. Thus the learned ZEVIANI alledges, that the

di 6

* This opinion was held by Boerliaave, and notTrithilanciin^ what
the Author fays at the end of this paragraph, the opinion is certain-
ly founded on experience.

353 PRACTICE

difeafe is produced by an acid from the milk with
\vhich a child is fed for the firft nine months of its
life ; but almoft air children are fed with the fame
food, and in which alfo an acid is always produced ;
while, at the lame time, not one in a thoufasd of the
infants fo fed becomes affected with the rickets. If,
therefore, in the infants who become affectect with this
difeafe, a peculiarly noxious acid is produced, we muft
feek for fome peculiar caufe of its production, either
in the quality of the milk, or in the conftitution of
the 'child ; neither of which, however, Mr. Zeviani
has explained. I cannot indeed believe that the or-
dinary acid of milk has any ihare in producing this
difeafe, becaufe 1 have known many inftances of thq
acid being produced and occaiioning various diforders,
without, however^ its ever producing rickets.

Another of the remote caufes commonly affigned, is.
the child being fed with unfermented farinaceous
food. But over the whole world children are fed
with fuch farinacea, while the difeafe of rickets is a
rare occurrence : and I have known many instances
where children have been fed with a greater than
ufual proportion of fermented farinacea, and alfo a
greater proportion of animal food, without thefe pre-
venting the difeafe. In my apprehenfion, the like
obfervations might be made with refpedt to moft of
the circuinftaaces that have been mentioned as the re-
mote caufes of rickets.

MDCCXXIV.

Having thus offered my opinion concerning the fup-
pofed antecedents of this difeafe, I proceed now to
mention the phenomena occurring after it has actual-
ly come on*.

The difeafe feldom appears before the ninth month,

and

* This admirable defcription of the difedfe merits the peculiar
attention of the young practitioner.

OF PHYSIC.

and feldom begins after the fecond year, cf a child's
age. In the interval between thefe periods, the ap-
pearance of the difeafe is fometimes fooner, fometimes
later ; and commonly at firft the difeafe comes on
flowly. The firft appearances are, a flaccidity of
the flefh, the body at the fame time becoming leaner,
though food be taken in pretty largely. The head
appears large with refpect to the body ; with the fon-
tanelle, and perhaps the futures, more open than ufual
in children of the fame age, The head continues to
grow larger ; in particular, the forehead becoming un-
ufually! prominent ; and at the fame time the neck con-
tinues (lender, or feems to be more fo, in proportion to
the head. The dentition is flow, or much later than
ufual ; and thofe teeth which come out, readily become
black, and frequently again fall cut. The ribs lofe
their convexity, and become flattened on the fides ;
while the fternum ispufhed outward, and forms a fort
of ridge. At the fame time, or perhaps fboner, the
epiphyfes at the feveral joints of the limbs become
fwelled ; while the limbs between the joints appear,
or perhaps actually become, moreflender. The bones
feem to be every where flexible, becoming varioufly
diftorted; and particularly the fpine of the back be-
coming incurvated in different parts of its length. If
the child, at the fame time the difeafe comes on, had
acquired the power of walking, it becomes daily more
1 feeble in its motions, and more averfe to the exertion
of them, lofmg at length the power of walking alto-
gether. Whilft thefe fymptoms go on increafing,
the abdomen is always full, and.preternaturally tumid.
The appetite is often good, but the ftools are general-
ly frequent and loofe. Sometimes the faculties of the
mind are impaired, and ftupidity or fatuity prevails ;
but commonly a premature fenfibility appears, and
they acquire the faculty of fpecch fooner than i
At the firft coming on of the difeafe, there is general-
ly

P R A C T I C E

•o fever attending it : but it feldoni continues L,
a frequent pulie, and other febrile lymptoms,

ly n j
lill

come to be conllantly prefent. With ihefe iymptoms1
ihe difeafe proceeds, and continues in fome initances
for fome years ; but very often, in the courfe of that
time, the. difeafe ceafes to advanee, and the health is
entirely eilabliilied, except that the diitorted limbs,
produced during the difeafe, continue for the reft of
life. In other cafes, however, the difeafe proceeds in-
creafmp;, till it has affected aimofl every function of
the animal oeconomy, and at length terminates in
death. The variety of fymptoms which in fuch cafes
appear, it does not feem necqlFary to enumerate, as
they are not eiTential to the conftitution of the difeafe,
but are merely confequences of the more violent con-
ditions of it. In the bodies of thofe who have died,
various morbid affections have been discovered in the
internal parts. Mofl of the vifcera of the abdomen
have been found to be preternaturally enlarged. The
kings have alfo been found in a morbid itate, feeming-
ly from fome inflammation that had come on towards
the end of the difeafe. The "brain has been common-
ly found in a flaccid ftate, with effuiions of a ferons
iiuid into its cavities. Very univeriklly the bones
have been found very foft, and fo much foftened as to
readily cut by a knife. The fluids have been always
found in a diffolved ilate, and the mufcular parts very
foft and tender ; and the whole of the dead body with-
out any degree of that rigidity which is fo common
in almoft all others.

MDCCXXV.

From thefe circumftances of tiic difeafe, it fcerasto
coniiit in n deficiency of that matter wliich iliould
.ithe Iblid parts of the body. This ef pec idly ap-
pears in the fauity ilaie of oiiificarion, ieemin^ty de-
j-;"ndJnt^ upon the deficiency of that matter which

ili'juld be denolired in the membranes which are del-

, • i
tinea

OF PHYSIC, 361

ftined to become bony,, and fhould give them their
due firmnefs and bony hardnefs. It appears that this
matter is not fupplied in due quantity ; but that, in
place of it, a matter fitted to increafe their bulk, par-
ticularly in the epiphyfes, is applied too largely*
What this deficiency of matter depends upon, is diffi-
cult to be afcemined. It may be a fault in the organs
of digetlion and aflimilation, which prevents the flu-
ids in general from being properly prepared : or it
may be a fault in the organs of nutrition, which pre-
vents the fecretion of a proper matter to be applied.
With refpedt to the latter, in what it may confiit, I
am entirely ignorant, and cannot even difcern rhat
fuch a condition exiils : but the former caufe, both
in its nature and exigence, is more readily perceived ;
and it is probable that it has a conficlerable influence in
the matter ; as in rachitic perfons a thinner (late of the
blood, both during life and after death, fo commonly
appears. It is this Hate of the fluids, or a deficiency
of bony matter in them, that I coniider as the proxi-
mate caufe of the difeafe ; and which again may in
ibme meafure depend upon a general laxity and debi-
lity of the moving fibres of the organs that perform
the fun&ionsof digeflion and aflimiiation.
MDCCXXVI.

There, is, however, fome thing ftill wanting to explain,
why thefe circumftances difcover themfelves at a par-
ticular time of life, and hardly ever either before or
after a certain period; and as to this I would offer the
following conjectures. Nature having intended that
human life fhould proceed in a certain manner, and
that certain functions mould be exercifed at a certain
period of life only ; fo it has generally provided, that
at that period, and not fooner, the body fhould be fit-
ted for the exercife of the functions fuited to it. To
apply this to our prefent fubject, Nature feems to ruve
intended that children fhould walk only at twelve

VOL. If. Z z mcnrhs

PRACTICE

months old ; .and accordingly has provided, that againft
that age, and no fooner, a matter fhould be prepared
fit to give that firm nefs to the bones which is neccffary
to prevent their bending too eafily under the weight
of the body. Nature, however, is not always fteady
and exafh in executing her own purpofes ; and if
therefore the preparation of bony matter (hall not have
been made againft the time there is particular occafi-
on for it, the difeafe of rickets, that is, of foft and flex-
ible bones, rnufl ct)me on ; and will diicover itfelf about
the particular period we have mentioned. Further, it
will be equally probable, that if at the period menti-
oned the bones ihall have acquired their due firmnefs,
and that nature goes on in preparing and fupplying the
proper bony matter, it may be prefumed, that againit
the time a child is two years old, fuch a quantity of
bony matter will be applied as to prevent the bones
from becoming again foft and flexible during the reft
of life ; unlefs it happens, as indeed it fometimes does,
that certain caufes occur to wafh out again the bony
matter from the membranes in which it had been de-
pofited. The account I have now given of the period
at which the rickets occur, feems to confirm the opi-
nion of its proximate caufe being a deficiency of bo-
ny matter in the fluids of the body.
MDCCXXVII.

It has been frequently fuppofed, that a fiphylitie
taint has a ihare in producing rickets ; but fuch a
fuppofition is altogether improbable. If our opinion
of the rickets having exifted in Europe before the fi-
phylis was brought into it, be well founded, it will
then be certain that the difeafe may be occafioned
without any fiphylitie acrimony having a ihare in its
production. But further, when a fiphylitie acrimony
is tranfmitred from the parent to the offspring, the
fymptoms do not appear at a particular time of life on-
ly, and commonly more early than the period of rick-
ets :

OF PHYSIC. 363

et&; the fymptoms alfo are very different from thofe
of rickets, and unaccompanied with any appearance of
the latter : and, laflly, the fymptoms of iiphylis are
cured by means which, in the cafe of rickets, have ei-
ther no eitccl:, or a bad one. It may indeed poilibly
happen, that Iiphylis and rickets may appear in the
fame perfon ; but it is to be confideied as an accident-
al complication : and the very few inftanccs of it that
have occurred, are by no means fufficient to eita-
blifh any neceflary connection between the two dif-

MDCCXXVIIL

With refpeel: to the deficiency of bony matter,
which I coniider as the proximate ca-ule of rickets,
fome further conjectures might be offered concerning
its remote cauies ; but none of them appear to me ve-
ry fatisfying ; and whatever they might be, it appears
to me they muft again be refolved into the fuppolition
of a general laxity and debility of the fyfttm.
MDCCXXIX.

It is upon this fuppolition ahnoft alone that the
cure of rickets has entirely proceeded. The remedies
have been fuch efpccially as were fuited to improve
the tone of the fyltem in general, or of the ftomach in
particular : and we know that the latter are not only
fuited to improve the tone of the ftomach itfelf, but
by that means to improve aiib the tone of the whole
fyiiem.

MDCCXXX.

Of tonic remedies^ one of the nio(t promiiuVg feems
to have been cold bathing ; and I have found it the
moil powerful in preventing the difeafe, For a long
time pad, it has been the practice in this country,
with people of all ranks, to wa/h, their children from
the time of their birth with cold wales >; and from
the time that children are ti month old, ut-has been
the practice with people of better rank to have "hem
Z z 2 cii]»}x-d

364 PRACTICE

clipped entirely in cold water every morning : and
wherever this pra&ice has been purfued, I have not
met with any inftance of rickets. Amongft our com-
mon people, although they warn their children with
cold water only, yet they do not f0 commonly pra&ife
immerfion : and when amongft thefe I meet with in-
flances of rickets, I prefcribe cold bathing ; which ac-
cordingly has often checked the progrefs of the dif-
eafe, and fometimes feems to have cured it entirely.
MDCCXXXL

The remedy of Ens Veneris^ recommended by Mr.
Boyle, and fince his time very univerfally employed,
is to be coniidered as entirely a tonic remedy. That
or fome other preparation of iron I have almofl con-
flantly employed, though not indeed always with
fuccefs. I have been perfuaded, that the ens veneris,
of Mr. Boyle, notwithstanding his giving it this appel-
lation, was truly a preparation of iron, and no other
than what we now name the Flores Martiales* : but
it appears, that both Benevoli and Buchner have em-
ployed a preparation of copper; and I am ready ta
believe it to be a more powerful tonic than the prepa-
rations of iron $.

MDCCXXXIL

Upon the fuppofttion of tonic remedies being pro-
per

* The dofe of this medicine is from four to twenty grains, it
mufl be o;iven in the form of a bolus. The young pra&itioner
ou<*ht to beware of prefcribing fiores martiales in pills, which will
fweli and crumble to pieces if they are not compofed of a confider-
able quantity of f-.'i - c s^ummi refin.

The Flores r ales, may be very conveniently given in a tinfture
of proof fpirit. There is a formula of it in the laft London Phar-
macopoeia, under the nam<;- of Tiuclura ferri Ammoniacalis. 1'he
dofe of it is a tea-fpoonful in a wine glafs of cold wa.ter, and it is a
veiy c/^.^ant form of adminifteririg chalybeates.

§ Copp£- is a very dangerous remedy, as was mentioned above in
the n •' -,s on article 1336. The Author had a very high opinion . :
-r as a tonic-

OF PHYSIC. 365

per in this difeafe, I have endeavoured to employ the
Peruvian bark : but Jrom the difficulty of adminifter-
ing it to infants in any ufeful quantity, I have not
been able to difcover its efficacy ; bur I arn very ready
to believe the teftimony of Be Haen upon this fub-
jedt*.

MDCCXXXIIL '

Exercife, which is one of the moft powerful tonics,
has been properly recommended for the cure of rick-
ets ; and as the exerciie of geitation only can. be em-
ployed, it ihouid always be, with the child laid in a
horizontal lituation ; as the carrying them or moving
them in any degree of an erect poflure, is very apt to
occafion fome diftortion. It is extremely probable,
that, in this difeafe, friction with dry flannels may be
found an ufeful remedy.

MDCCXXXIV.

It is alfo fufficiently probable, that the avoiding of
moiittire is not only advifable, but may likswife be cf
fervice in the cure of this difeafe.

There is no doubt that a certain diet may contribute
to the fame end ; but what may be the moft eligible,
I dare not determine. I have no doubt that leaven-
ed bread may be more proper than unfermented fari-
nacea ; but I cannot find any reafon to believe that
firong beer can even be a proper remedy.

Pradli-

* It is daubtlefs difficult to make children f wallow a fufEcient quan-
tity of bark to produce any good effects, yet it is not impoflible,
The formula befc adapted for children, is the powder of the extract ;
but as it fometimes occafions conilipation, this effed muft be guarded
agairitt by fome proper laxatives, eipecially by Rhubarb given either
with the bark or feparately. The following formula is a proper dofe
for a child of two years old, to be repeated twice a-clay ;
I>. Extr. Cort. PCTUV. dur. gr. viii.
Pulv. Had. Rhei. gr. x.
Sacch. alb. <*r. xv.
M. f. pulv. "

366 P R A C T I C E

Practitioners have been divided in opinion concern*
ing the ufe of milk in this difeafe. Zeviani, perhaps
from theory, condemns the ufe of it ; but Benevoli
employed it without its impeding the cure of the dif-
eafe. This laft I have often remarked in the courfe of
my own practice. As it is difficult to feed children
entirely without milk ; fo I have commonly admitted
it as apart of the diet of rickety children ; and in ma-
ny inftances I can affirm, that it did not prevent the
cure of the difeafe. In cafes, however, of any appear-
ance of rickets, and particularly of a flow dentition, I
have difTuaded the continuance of a child upon the
bread ; becaufe the milk of women is a more watery
-nounfhrnent than that of cows : and I have efpecially
diffuaded the continuing a child upon the breaft,
when I thought the nurfe gave rather too much of
fuch a watery nourishment ; for, as has been above
mentioned, I have had frequent occalion to fuipect,
that the milk of fuch nurfes-has a tendency to fa.vour
the coming on of rickets*.

MDGCXXXV.

Befides the remedies and regimen now mentioned,
practitioners have commonly employed in this difeafe,
both emetics and purgatives. When the appetite and
digeition are confiderably impaired, vomiting, if nei-
ther violent nor frequently repeated, feems to be of
fervice ; and, by a moderate agitation of the abdomi-
nal vifcera, may in.fome meafure obviate the ftagna-
tion and confequent fwelling that ufually occur in
them.

As the tumid flate of the abdomen, fo constantly to
be met with in this difeafe, feems to depend very much
upon a tympanitic afFeclion of the interlines ; fo, both
by obviating this, and by deriving from the abdomi-
nal vifcera, frequent gentle purgatives may be of fer-
vice •

* How does this accord with the laft fentence of article i 722.

O F P H Y S I C. 367

tree. Zeviani, perhaps properly, recommends in par-
ticular rhubarb ; which, betides its purgative quality,
has thofe alfo of bitter and aftringent.
MDCCXXXVI.

I have now mentioned moil of the remedies com-
monly employed by the practitioners of former times ;
but I mii-ft not omit mentioning fome others that have
been lately fuggefted. The late Mr. De Haen re-
commends the teftacea ; and afTures of their having
been employed with fuccefs ; but in the few trials
which I have had occafion to make, their good effects
did not appear.

The late Baron Van Swieten gives us one inftance
of rickets cured by the life of hemlock ; but I do not
know that the practice has been repeated.

BOOK III.

OF THE

I M P E T I G I N I S;

O R

DEPRAVED HABIT, WITH AFFECTIONS OF
THE SKIN.

MDCCXXXVIL

1FIND it difficult to give any fufficiently correct
and proper character of this order. The difeafes
comprehended under it, depend, for the mod part, up-
on a depraved flare of the whole of the fluids, produc-

ng

363 PRACTICE

ing tumours, eruptions, or other preternatural ai-
tions of the (kin. Although it be extremely difficult
to find a general character of the order that will ap-
ply to each of the genera and fpecies, I ihall here treat
of the principal genera which have been commonly
comprehended under this order, and which 1 have
enumerated in my Nofology.

CHAP. I.

OF SCROPHULA, OR THE KING's EVIL:

MDCCXXXVilL

THE character of this difeafe I have attempted in
my Nofology : but it will be more properly
taken from the whole of its hiftory, now to be deliver-
ed.

MDCCXXXIX.

It is commonly, and very generally, a hereditary
difeafe ; and although it fometimes may, yet it rarely
appears, but in children whofe parents had at fome
period of their lives been affected with it. Whether
it may not fail to appear in the children of fcrophu-
lous parents, and difcover itfelf afterwards in their
offspring in the iucceeding generation, I cannot cer-
tainly determine; but believe that this has frequently
happened. It appears to me to be derived more com-
monly from fathers than from mothers; but whether
this happens from there being more fcrophulous men
than fcrophulous women married, I am not certain.

With refpect to the influence of parents in produc-
ing this difeafe, ir cleferves to be remarked, that in a.
family of many children, \vhta one of the parents has

• been

O F P H Y S I C. 369,

been aiTe&ed with fcrop-hula, and the other not;
as it is ufual for fome of the children to be in con-
ilitution pretty exactly like the one parent, and others
of them like the other; it commonly happens, that
thofe children who moft refemble the fcrophulous pa-
rent become affeded with fcrophula, while thofe re-
fembling the other parent entirely efcape.
MDCCXL.

The fcrophula generally appears at a particular pe-
riod of life. It feldom appears in the firit, or even in
the fecond year of a child's life ; and moil commonly
it occurs from the fecond, or, as fome alledge, and per-
haps more properly, from the third, to the feventh
year.. Frequently, however, it difcovers itfelf at a
later period ; and there are inflances of its firft appear-
ance, at every period till the age of puberty ; after
which, however, the firft appearance of it is very
tare.

MDCCXLI.

When it does not occur very early ,|we can general-
ly diftinguifh the habit of body peculiarly difpofed to
it. It moft commonly affecls children of foft and
flaccid habits, of fair hair and blue eyes ; or at leaft
affeds thofe much more frequently than thofe of an
oppoiite Complexion. It afFecls efpecially children of
fmooth ikins and rofy cheeks ; and fuch children have
frequently a tumid upper lip, with a chop in the mid-
dle of it; and this tumour is often conliderable, and
extended to the columna nali and lower part of the
noflrils* The difeafe is fometimes joined with, or
follows rickets ; and although it frequently appears in
children who have not had rickets in any great degree^
yet it often attacks thofe who, by a protuberant forer
head, by tu.*nid joints, and a tumid abdomen, fliow
that they had fome rachitic difpofition. In parents
who, without having had the difeafe themfelves, feeni
to produce fcrophulous children, we can commonly

VOL. II. 3 A per-

370 PRACTICE

perceive much of the fame habit and conftitution that
has been juft now defcribed.

Some authors have fuppofed that the fmall-pox has
a tendency to produce this difeafe ; and Mr. De Haen
ailerts its following the inoculated, more frequently
than the natural fmall-pox. This lad pofition, how-
ever, we can confidently affirm to be a miftake; al-
though it mufl be allowed, that in fact the fcrophula
does often come on immediately after the fmall-pox.
It is, however, difficult to find any connection between
the two difeales. According to my obfervation, the
accident only happens in children who have pretty
manifeftly the fcrophulous difpofition ; and I have had
feveral inftances of the natural fmall-pox coming up-
on children affected at the fame time with fcrophula,
not only without this difeafe being any ways aggravat- .
ed by the fmall-pox, but even of its being for fome
time after much relieved.

MDCCXLH.

The fcrophula generally {hows itfelf firfl at a par-
ticular feafon of the year ; and at fome time between
the winter and fummer folftice ; but commonly long
before the latter period. It is to be obferved further,
that the courfe of the difeafe is ufually connected with>
the courfe of thp feafons. Whilfl the tumours and
ulcerations peculiar to this difeafe, appear firfl in the
fpring, the ulcers are frequently healed up in the
courfe of the fucceeding fummer, and do not break out
again till the enfuing fpring, to follow again with the
feafon the fame courfe as before.

MDCCXUII.

Frequently the firft appearance of the difeafe is the
tumid and chopped lip above mentioned. .Upon other
occafions, the firft appearance is that of ftnall fpheri-
cal or oval tumours, moveable under the fkin. They
are foft> but with fome elafticity. They are without
pain; and without any change in the colour .of the

OF PHYSIC 371

ikin; In this ftate they often continue for a long
time ; even for a year or two, and fumetimes longer.
Mofl commonly they firft appear upon the fides of
the neck below the ears ; but fometimes alfo under
the chin. In either cafe, they are luppofed to affecl:
in thefe places the conglobate or lymphatic glands
only : and not at all the faltvary glands, till the dif-
eafe is very greatly advanced. The difeafe frequently
affects, and even at firit appears in, other parts of the
body. In particular, it affeds .the joints of the elbows
and ankles, or thofe of the fingers and toes. The ap-
pearances about the joints are not commonly, as elfe-
where, fmall moveable fwellings ; but a tumour almofl
uniformly furrounding the joint, and interrupting its
motion.

MDCCXLIV.

Thefe tumours, as I have laid, remain for fome time
little changed ; and, from the time they firft appear
in the fpring, they often continue in this way till the
return of the fame feafon in the next, or perhaps the
fecond year after. About that time, however, or per-
haps in the courfe of the feafon in which they firft ap-
pear, the tumour becomes larger and more fixed ; the
ikinupon it requires a purple, feldom a clear rednefs :
but growing redder by degrees, the tumour becomes
fofter, and. allows the fluctuation of a liquid within to.
be perceived. All this procefs, however, takes place
with very little pain attending it. At length fome
part of the (kin becomes paler ; and by one or more
fmall apertures a liquid is poured out.
MDCCXLV.

The matter poured out has at firft the appearance of
pus, but it is ufually of a thinner kind than that from
phlegmon ic ahfcelfes ; and the matter as it continues
to be difcharged, becomes daily lefs purulent, and ap-
pears more and more a vifcid ferum, intermixed with
fmail pieces of a white fubftance refembling the curd
of milk. By degrees the tumour almoft entirely fub-

3 A 2 fides

37-2 PRACTICE

fides while the ulcer opens more, and fpreads broad-
er : unequally, however, in different directions, and
therefore is without any regular circumfcription. —
The edges of the ulcer are commonly flat and fniooth,
both on their outride and their inner edge, which fel-
dom puts on a callous appearance. The ulcers, how-
ever, do not generally fpread much, or become deep-
er ; but at the time their edges do not advance, or put
on any appearance of forming a cicatrix.
MDCCXLVL

In this condition the ulcers often continue for a
long time ; while new tumours, with ulcers fucceed-
ing them in the manner above defcribed, make their
appearance in different parts of the body. Of the
firit ulcers, however, forne heal up, while other tu-
mours and ulcers appear in their vicinity, or in other
parts of the body ; and in this manner the difeafe
proceeds, fome of the ulcers healing up, at lead to a
certain degree, in the courfe of fumfner, and breaking
out again in the fucceeding fpring ; or it continues,
by new tumours and ulcers fucceeding them, in che
fpring feafon, making their appearance (ucceffively for
feveral years.

MDCCXLVIL

In this way the difeafe goes on for feveral years :,
but very commonly in four or five years it is fpontane-
oufly cured, the former ulcers being healed up, and
no new tumours appearing ; and thus at length the
difeafe ceafes entirely, leaving only fome indelible
efchars, pale andfmooth, but in fome parts fhrivelled;
or, where it had occupied the joints, leaving the mo-
tion of thefe impaired, or entirely defiroyed.
MDCCXLVIII.

Such js the moil favourable courfe of this difeafe ;
and with us, it is more frequently fuch, than other-
wife : but it is often a more violent, and fomctimes a
fatal malady- In thefe cafes, more parts of the body

are

OF PHYSIC. 373

are at the fame time affe&ed ; the ulcers alfo feeming
to be imbued with a peculiar fharp acrimony, and
therefore becoming more deep, eroding, fpreading, as
well as feldomer healing up. In fuch cafes, the eyes
are often particularly affected. The edges of the eye-
lids are affected with tumour, and furxerficial ulcera-
tions ; and thefe commonly excite obiunate inflamma-
tion in the adnata, which frequently produces an opa^
city of the cornea.

When the fcrophula efpecially affects the joints, it
fometimes produces there confiderable tumours ; in
the abfceffes following which, the ligaments and car-
tilages are eroded, and the adjoining bones are affect-
ed with a caries of a peculiar kind. In thefe cafesa
alfo, of more violent fcrophula, while every year pro-
duces a number of new tumours and ulcers, their acri-
mony feems at length to taint the whole fluids of the
body, occaiioning various diforders ; and particularly
a hectic fever, with all its fymptoms, which at length
proves fatal, with fometimes the fymptoms of plnhifis-,
pulmonalis.

MDCCXLIX.

The bodies of perfons who have died of this difeafe
ftiow many of the vifcera in a very morbid ffote ; and
particularly moil of the glands of the mer-icntcry
very much tumefied, and frequently in an ulcerated
{late. Commonly alfo a great number of tubercles
or cyfis, containing matter of various kinds, appear in
the lungs.

MDCCL,

Such is the hifiory of the difeafe ; and from thence
it may appear, that the nature of it is not eafily to be
afcertained. It feems to be a peculiar affection of the
lymphatic fyftcm ; and this in fome meafure accounts
for its connection with a particular period of life.
Probably, however, there is a peculiar acrimony of the
fluids that is in the proximate caufe of the difeafe ; al~

though

PRACTICE

though of what nature this is, has not yet been difco.^
vered. It may perhaps be generally diffufed in the
fyftein, and exhaled into the feverai cavities and cellu^
lar texture of the body : and therefore, being taken
up by the abforbents, may difcover itfelf efpecially in
the lymphatic fyftem, .This, however, will hardly
account for its being more confined to that fyftem,
than happens in the cafe of many other acrimonies
which may be fuppofed to be as generally diffufed. —
In mort5 its appearance in particular conftitutions, and
at a particular period of life, and even its being a
hereditary difeafe, which fo frequently depends upon
the tranfmiilion of a peculiar conflitution, are all of
them circumftances which lead me to conclude, upon
the whole, that this difeafe depends upon a peculiar
conjliiution of the lymphatic fyftem.
MDCGLI.

It feems proper to obferve here, that the fcrophula-
does not appear to be a contagious difeafe; at lead I
have known many inftances of found children having
had frequent and clofe intercourle with fcrophulous
children without being infected with the difeafe. This
certainly ihows, that in this difeafe the peculiar acri-
mony of it is not exhaled from the furface of the body^
but that it depends efpecially upon a peculiar cpnili-
tution of the fyftem.

MDCCLII.

Several authors have fuppofed the fcrophula to have
been derived from the venereal difeafe ; but upon no
jull grounds that I can perceive. In very many in-
itances, there can hardly be any fufpicion of the pa-
rents producing this difeafe having- been imbued with
iiphylis to their offspring, in whom, however, no fcro-
phulous fymptoms at any time afterwards appeared.
Further, the fymptoms of the two difeafes are very dif-
ferent ; and the difference of their natures appear par-
ticularly from hence, that while mercury commonly

end

O F P H Y S I C, 375

and readily cures the fiphylis, it does no fervice in
fcrophula, and very often rather aggravates the dif-
eafe.

MDCCLIII.

For the cure of fcrophula, we have not yet learned
any pradice that is certainly or even generally fuccefs-
ful.

The remedy which feems to be the moft fuccefsful,
and which our praditioners efpecially truft to and
employ, is the ufe of mineral waters ; and indeed the
wafhing out, by means of thefe, the lymphatic fyftem,
would feem to be a meafure promifing fuccefs : but iri
Very many inftances of the ufe of theie waters, I have
not been well fatistied that they had fhortened the dd-
ration of the difeafe more than had often happened
when no fuch remedy had been employed.

MDCCL1V.

With regard to the choice of the mineral waters
moil fit for the purpofe, I cannot with any confidence
give an opinion.

A 1 moft all kinds of mineral waters, whether chaly-
beate, fuiphureous, or faline, have been employed for
the cure of fcrophula, and feemingly with equal fuc-
cefs and reputation : a circumftance which leads me to
think, that, if they are ever fuccefsful, it is the ele-
mentary water that is the chief part of the remedy.

Of late, fea- water has been efpecially recommend-
ed and employed ; but after numerous trials, I cannot
yet difcover its fuperior efficacy.
MDCCLV

The other remedies propofed by pradical writers
are very numerous ; but, Hpon that very account, I
apprehend they are little to be trufted : and as I can-
not perceive any juft reafon for expeding fuccefs from
them, I have very feldom employed them.

Of late, the Peruvian bark has bt-esi much recom-
mended : and as in fcrophulous perfons there are ge-
nerally

376 PRACTICE

herally fome marks of laxity and flapcidity, this tonic
may pouToly be of fervice ; but in a great variety of
trials, I have never fecnit produce any immediate cure
of the difeafe.

In feverai inftances, the leaves of colts-foot have
appeared to me to be fuccefsfui. I have ufed it fre-
quently in a ftron-g decoction, and even then with ad-
vantage : but have found more benefit from the ex-
preiTed juice, when the plant r.ould be had in fomewhat
of afucculent ftate, foon after its firft appearance in the
fpring. MDCCLVI.

I have aifo frequently employed the hemlock, and
have fometimes found it uieful in difcufling obfiinate
fwellings : but in this, it has alfo often difappointed
me : and I have not at any time obferved that it dif-
pofed fcrophulous ulcers to heal.

I cannot conclude the fubjedt of internal medicines
without remarking, that I have never found either
mercury or antimony, in any iliape, of ufe in this dif-
eafe; and when any degree of a fevcriih ftate had
come on, the ufe of mercury proved manifeftly hurtful.

MDCCLVII-

In the progrefs of fcrophula, feveral external medi-
cines are requifite. Several applications have been
vtfed for difcuffing the tumours upon their firft com-
ing on ; but hitherto my own practice, in thefe re-
fpects, has been attended with very little fuccefs. —
The folution of the faccharum faturni has feemed to
be ufeful ; but it has more frequently failed : And I
have had no better fuccefs with the fpiritus Mindereri.
Fomentations of every kind have been frequently
found to do harm ; and poultices feem only to hurry
on a fuppuration. I am doubtful if this lafl be ever
praclifed with advantage ; for fcrophulous tumours
fometimes fpontaneouily dilappear, but never after a-*
ny degree of inflammation has come upon them ; and
therefore poultices, which commonly induce in-
flammation

OF PHYSIC, 377

flammation, prevent that difcuffion of tumours, which
might other wife have happened.

Even when fcrophulous tumours have advanced to-
wards fuppuration, I am unwilling to haften the fpon-
taneoiis opening, or to make it by the lancet ; becaufe
I apprehend the fcrophulous matter is liable to be ren-
dered more acrid by cdmmunicanon with the air, and
to become more eroding and ipreadihg than when irt
its inclofed ftate.

MDCCLVill.

The management of fcrophulous ulcers has, fo far
as I know, been as little fuccefsful as that of the tu-
mours. Efcharotic preparations, of either mercury or
copper have been fometimes ufeful in bringing on a
proper fuppuration, and thereby difpofing the ulcer to
heal ; but they have feldom fucceeded, and more com-
monly they have caufed the ulcer to fpread more. Trie
efcrurotic from which I have received mofl benefit
is burnt alum, and a portion of that mixed with a
mild ointment, has been as ufeful an application as a-
ny I have tried. The application, however, that I
have found mofl ferviceable and very ufiivefially ad-
miilible, is that of linen cloths wetted with cold water,
and frequently changed when they are becoming dry,
it being inconvenient to let them be glued to the fore.
They are therefore to be changed frequently during
the day ; and a cloth fpread with a mild ointment or
plaifter may be applied for the night. In this prac-
tice I have fometimes employed fea-water; but gene-
rally it proved too irritating; and neither that nor any
mineral water has appeared to be of more fervice than
common Water.

MDCCLIX.

To conclude what I have to offer upon the cure of
ferophula, I mufl obferve, that cold bathing feems to
have been of more benefit than any other remedy
that I have had occafion to fee employed.

VOL. II. 3 B C II A P.

373 PRACTICE

CHAP. II.
OF S1PHILIS, OR THE VENEREAL DISEASE,

MDCCLX.

AFTER practitioners hare had fo much experi-
ence in treating this difeafe, and after fo many
books have been publimed upon the fubjecl, it does
not feem neceflary, or even proper, for me to attempt
any full treatife concerning it; and I (hall therefore
confine myfelf to fuch general remarks, as may ferve
to illuftrate fome parts of the pathology or of the
practice.

MDCCLXI.

It is fufficiently probable, that, anciently, in certain
parts of Alia, where the leprofy prevailed, and in Eu-
rope after that difeafe had been introduced into it, a
difeafe of the genitals, refembling that which now
commonly arifes from fiphylis, had frequently appear-
ed : but it is equally probable, that a new difeafe, and
what we at prefent term Sipbytis^ was firfi brought in-
to Europe about the end of the fifteenth century ; and
that the diftemper now fo frequently occurring, has
been very entirely derived from that which was im-
ported from America at the period mentioned*.

MDCCLXII.

* Various opinions have been held by different phyficians about
the origin of this difeafe ; fome fuppofmg it to have exilted in the
old world, while others think it was imported from the new world,
clifcovered by Columbus. The difpute produced many controverfial ^
tra<fls, from the perufal of which, the young practitioner can gain
Jittle advantageous knowledge. All that we certainly know about
th? origin of the difeafe is, that it was firft obferved among the French ?
when they were at Naples in the year 1493, and that it was brought
into France by the French who returned thither with Charles. Co-
lumbus landed at Palos on the I5th of March in the fame year, on
his return from his firft voyage. The difeafe therefore, if imported
by Columbia's crew muft have fpread rapidly through Europe.

OF PHYSIC. 379

MDCCLXII.

This difeafe, at leaft in its principal circumftances,
never arifes in any perfon but from feme communi-
cation with a perfon already affected with it. It is
mod commonly contracted in confequence of coition
with an infected perfon ; but in what manner the in-
fection is communicated, is not clearly explained. I
am perfuaded, that in coition, it is communicated
without there being any open ulcer either in the per-
fon receiving the infection j but in all other cafes, I
believe it is never communicated in any other way
than by a contact of ulcer, either in the perfon com-
municating, or in the perfon receiving the infection.
MDCCLXIII.

As it thus arifes from the contact of particular parts,
fo it always appears firft in the neighbourhood of the
parts to which the infecting matter had been immedi-
diateiy applied ; and therefore, as mod commonly
contracted by coition, it generally appears firft in the
genitals.

MDCCLXIV.

After its firft appearance in particular parts, more
efpecially when thefc are the genitals of either fex, its
effects for fome time feem to be confined to chefe
parts; and indeed, in many cafes, never extends fur-
ther. In other cafes, however, the infecting matter
paiTes from the parts firft affected, and from the geni-
tal, therefqre, into the blood-veil^ls ; and being there
dirnifed, produces diforders in. many other parts of
the body.

From this view of the circumilances, phyficians
have very properly diftingtiifhed the different (tares of
the difeaie, according as they are local or are more
imiverfal. To the former, they have adapted appella-
tions fuited to the manner in which the difeaie ap-
pears ;• and to the other the general affection, they
have almofl totally confined the appellations of Sipbv-

3 B 2 //>,

380 PRACTICE

Us, Lues Venerea^ or Pox. In the remarks I am now
to offer, I fhall begin with confidering the local affec-
tion.

MDCCLXV.

This local affection appears chiefly in_ the form of
gonorrhoea or chancre.

The phenomena or gonorrhoea, either upon its firft
coming on or in its after progrefs, or the fymptoms of
ardor urinae, chordee, or others attending it, it is not
neceffary for me to defcribe. I fhall only here obferve,
that the chief circumftance to be taken notice of, is
the inflamed ftate of the urethra, which I take to be
infcparable from the difeafe.

MDCCLXVI.

In thefe well-known circumftances, the gonorrhoea
Continues for a time longer or fhorter, according to
the confutation of the patient ; it ufually remaining
longefb in the mofl vigorous and robuft, or according
to the patient's regimen, and the care taken to relieve
or cure the difeafe. In many cafes, if by a proper re-
gimen the irritation of the inflamed fiafe is carefully
avoided, the gonorrhoea fpontaneouily ccafes, the
fymptoms of inflammation gradually abating, the mat-
ter difcharged becoming of a thicker and more vifcid
confidence, as well as of a whiter colour ; till at
length, the flow of it ceafes altogether; and whether
it be thus cured fpontaneoufly, or by art, the difeafe
often exifls without communicating any infection to,
the other parts of the body,

MDCCLXVII,

In other cafes, however, the difeafe having been
neglected, or by an improper regimen aggravated, it
continues with ail its fymptoms for a long time'; and
produces various other diibrders in the genital parts,
which, as commonly taken notice of by authors, need
not be defcribed here. I fhall only obferve, that the
inflammation of the urethra, which at firft feems to

be

OF P H Y S I C. 381

be feated chiefly, or only, in its anterior parts, is in
fuch neglected and aggravated cafes fpread upwards
along the urethra, even to the neck of the bladder.
In thefe circumftances, a more confiderablc inflam-
mation is occafioned in certain parts of the urethra;
and confequently, fuppuration and ulcer are produc-
ed, by which the venereal poifon is fometimes com-
municated to the fyftem, and gives rife to a general
fiphylis.

MDCCLXVIII.

It was fome time ago a pretty general fuppofition,
that the gonorrhoea depended always upon ulcers of
the urethra, producing a difcharge of purulent mat-
ter \ and fuch ulcers do indeed fome times occur in
the manner that has been juft now mentioned We
are now affured, however, from many directions of
perfons who had died when labouring under a goncr-
rhcea, that the diieafe may exifl, and from many con-
fiderations it is probable that it commonly does exifl:,
xvithout any ulceration of the urethra ; ib that the dif-
charge which appears, is entirely that of a vitiated mu-
cus !rom the mucous follicles of the urethra.
MDCCLXIX,

Although moil of the fymptoms of gonorrhoea
fliould be removed, yet it often happens that a mu-
cous fluid continues to be difcharged from the urethra
for a long time after, and fometimes for a great part
of a perfon's life. This difcharge is what is common-
ly called a Gleet.

With refpecl to this, it is proper to obferve, that in
fome cafes, when it is certain that the matrer difcharg-
ed contains no venereal poifon, the matter may, and
often does, put on that puriform appearance, and that
yellow and greenim colour, which appears in the dif-
charge at the beginning and during the courfe of vi-
rulent gonorrhoea. Thefe appearances in the matter
of a gleet, which before had been of a lefs coloured

kind,

332 PRACTICE

kind, have frequently given occafion to fuppofc that a
frem infection had been received : but I am certain
that fuch appearances may be brought on by, per-
haps, various other caufes ; and particularly, by in-
temperance in venery and drinking concurring toge-
ther. I believe, indeed, that this feldom happens to
any but' thofe who had before frequently laboured
under a virulent gonorrhoea, and have more or lefs of
gleet remaining with them : but I mufl alfo otfferve,
that in perfons who at no period of their life had ever
laboured under a virulent gonorrhoea, or any other
fymptom of fiphylitic affection, I have met with in-
ftances of difcharges from the urethra refembling
thofe of a virulent gonorrhoea.

The purpofe of thefe obfervations is, to fuggeft to
practitioners what I have not found them always aware
of, that in perfons labouring under a gleet, fuch a re-
turn of the appearances of a virulent gonorrhoea may
happen without any new infection having been receiv-
ed, and confequemly not requiring the treatment
which a new infection might perhaps demand. When,
in the cure of gonorrhoea, it was the practice ta em-
ploy purgatives very frequently, and fometimes thofe
of the draftic kind, I have known the gleet, or fpuri-
ous gonorrhoea, by fuch a pra&ice much increafed
and long continued, and the patient's conftiturion ve-
ry much hurt. Nay in order more certainly further
to prevent miftakes, it is to be obferved, that the fpu-
rious .gonorrhoea is fometimes attended with heat of
urine/ and fome degree of inflammation; buttthefe
fymptorns are feldom confiderable, and, merely by
the arMance of a cool regimen, commonly difappear
in a few days.

MDCCLXX.

With refpecl to the cure of a virulent gonorrhoea,
I have only to remark, that if it be true, as I have men-
tioned above, that the difeafe will often, under a pro-
per

OF PHYSIC. 383

per regimen, be fpontaneouily cured ; and that the
whole of the virulent matter maybe thus entirely
difcharged without the affiftance of art ; it would
feem that there is nothing required of practitioners,
but to moderate and remove that inflammation which
continues the difeafe, and occaiions all the trouble-
fome fymptoms that ever attend it. The fole bu-
linefs therefore of our art in the cure of gonorrhoea, is
to take off the inflammation accompanying it : and
this I think may commonly be done, by avoiding ex-
ercife, by ufing a low and cool diet, by abftaining en-
tirely from fermented and fpirituous liquors, and by
taking plentifully of mild diluent drinks.*

MDCCLXXL

* This fimplc method of curing a gonorrhoea is, in many cafes,
fufficient, but it can only be depended on when the difeafe is flight
and the patient of a healthy conltitution. As every virulent gonor-
ihcea is evidently produced by the a&ion of the venereal poifon, the
judicious practitioner will feldom trull to this method without the
ufe of mercurials after the inflammatory fymptoms have been fome
what fubdued. They ought to be given in fuch cafes in very fmall
quantities, fo as to produce only a flight effect on the mouth ; and
their ufe ought to be continued till every fymptoro-difappears.

Mercury may be ufed internally or externally as occaiion may re-
quire ; if it does not affect the bowels nor purge, the common mer-
curial pill of the Edenburgh pharmacopcea is as good a formula as
any we have in the fhops. It's dofe muit be regulated by the effects
it produces. In general, we begin with a four grain pill every night,
and continue that quantity till the gums be flightly affected, or a
coppery taftc be perceived in the mouth. When either of thefe
fymptoms appear, we are certain that the mercury is received, in A
fufficient quantity, into the general mafs of the blood, for deilroying
the venereal virus, and then a pill may be given once in two or three
days, fo as to keep up the fame flight affection of the mouth, but
without increafing it. If the pill purges, we then are to have rc-
courfeto the ftrong mercurial ointment, half a dram of which muit
be rubbed into the hams night and morning, till the mouth be af-
fected in the manner above defcribed.

The patient ought to wear flannel drawers during the whole time
of the continuing the rubbing, which oaght to be i emulated by the
degree of affection perceived in the mouth. The ufe either of the
pill or of friction muft be continued eight or tcti days after every
fymptom of the difeafe has disappeared,

384 PRACTICE

MDCCLXXI.

The heat of urine, which is fo troublefome in this
difeafe, as it arifes from the increafed feniibi^y of the
urethra in its inflamed {late ; fo, on the other hand, the
irritation of the urine has the effeft of incrcafmg the
inflammation, and is therefore to be removed as foon
as poffible* This can be done moil effectually by tak-
ing in a large quantity of mild watery liquors. De-
mulcents may be employed; but unlefs they be ac-
companied with a large quantity of water, they will-
have litt le effecl.* Nitre has been commonly employ-
ed as a fuppofed refrigerant . but, from much obfer-
vation, I am convinced, that in a fmall quantity it is
tifeieis, and in a large quantity certainly hurtful* ; and
for this reafon, that every faline matter palling with
the urine generally gives fome irritation to the urethra,,
To prevent the irritation of the urethra arifing from
its increafed feniibility, the injection of mucilage or of
mild oil into it has been pra&ifed j but i have feldom
found this of much fervice*

MDCCLXXII.

In gonorrhcea, as conftivenefs may be hurtful, both
by an irritation of the fyfteiii in general, and of the
urethra in particular, as this is occasioned always by the
avoiding of hardened faeces ; fo conitivenefs is to be
carefully avoided or removed ; and the frequent ufe of
large glyfters of water and oil, I have found of remar-
kable benefit in this difeafe. If glyfters, however, do

hot

* Lintfeed-tca,a very thin deco&ion of marm-mallow root, or
thin barley-water, will, in moil cafes, anfwer the intention fufiident-
ly well. The common almond emulfion has been recommended in
thefe cafes, and when taken in large quantities is certainly very effica-
cious. It may be ufed as the patient's common drink.

•j* The ufe of nitre has been itrongly recommended by many practi-
cal writers, in cafes of iimple gonorrhoea accompained with this iymp-
torn ; but it muft be acknowledged, (as the author jufdy obfcrves,)
to be hurtful by it's irritating quality. It is certainly a rcfringefant^

OF P II Y S I C 385

toot entirely obviate coftivenefs, it will be ncceflary to
give laxatives by the mouth : which, however, iliould
be of the rnildeft kind, and fiiould do no more than
keep the belly regular and a little Icofe, without much
purging*.

The .pVa&jce of frequent purging, which was for-
merly fo much in ufe, and is not yet entirely laid afide,
has always appeared to me to be generally fuperfluous,
and often very hurtful. Even what are fuppofed to
be cooling purgatives, fuch as Glauber's fait, foluble
tartar, and crystals of tartar, in fo far as any part of them
pafsby urine, they, in the fame manner as we have faid of
nitre, may be hurtful ; and fo far as they produce very li-
quid (tools, the matter of which isgenerally acrid, they ir-
ritate the rectum, and confequently the urethra. This
iaft effect, however, the acrid, and in any degree draf-
ric, purgatives, more certainly produce.
MDCCLXXIIL

In cafes of a gonorrhcea attended with violent infj ani-
mation, blood-letting may be of fervice ; and in the
cafe of perfons of a robufl and vigorous habit, in whom
the difeafe is commonly the nioft violent, blood-letting
may be very properly employed. As general bleed-
ings, however, when there is no phlogiftic diathefis in
the fyftem, have little effect in removing topical in-
flammation ; fo in gonorrhcea, when the inflammation
is confiderable, topical bleeding applied to the urethra

VOL, II. 3 C by

and as fuch is allaying the inflammatory fymptoms ; but it is insd-
miflible in cafes where the ardor unnae is violent.

* A tea-fpoonful of the following elc&uary taken occafionaily
will keep the belly fuiEciently open.
]$,. Pulv. Jalap. 51.

Nitri. $\i.
Elect. Lenitiv. §?.
Syr. Simpl. q, f.
M. f ELft.

336 PRACTICE

by leeches, is generally more effectual in relieving the
inflammation*.

MDCCLXXIV.

When there is any phymofis attending a gonorrhoea,
einolient fomentations applied to the whole penis are
often of fervice. In fuch cafes it is neceflary, and in
all others ufeful, to keep the penis laid up to the bel-
ly, when the patient either walks about or is fitting^.
MDCCLXXV.

Upon occailon of frequent priapifoi and chordee, it
has been found ufeful to apply to the whole of the pe-
nis a poultice of crumb of bread moiflened with a
ilrong folution of fugar of lead. I have, however,
been often difappoinred in this practice, perhaps by the
poultice keeping the penis too warm, and thereby
exciting the very fymptoms I wiihed to prevent.
Whether lotions of the external urethra with a folution
of the fugar of lead, might be ufeful in this cafe, I have
not properly triedf .

MCCCLXXVI.

With refpect to the ufe of injections, fo frequently
employed in gonorrhoea, I am perfuaded that the early
ufe of aftringent injections is pernicious j not by oc-

cafioning

* The good effe&s ofleeches in thefe cafes are confirmed by ex-
perience. They may be applied on the under fide of the penis, and*
three or four thus applied have freq-uently produced amazing effeds.
The operation, however, is extremely painful, and is feldom fub-
mitted to a fecond time by a patient who has once experienced it.

§ In all cafes of inflammation of the urethra thefe emollient ap-
plications give great relief. The common white bread poultice may-
be ufed during the night time or while the patient is in bed ; and,
warm flannels impregnated with lintfeed-tea while he is fitting up.

f The fugar of lead folution may perhaps be objected againlt on
account of it's flopping the difcharge, and inducing a fwelled tefticle,
which has fometimes followed it's application. Wrapping the penis
up in linen rags wet with cold water, frequently anfwers the purpofe
of preventing the violence of the fymptoms, as well as any more
complicated application. The cold wet rags ought to be renewed
v/heneverthcy grow warm,

OF PHYSIC. 387

cafioning a fiphylis, as has been commonly imagined;
but by increafing and giving cccafion to all the confe-
quences of the inflammation,, particularly to the very
troublefome fymptoms of fwelled tefticles. When,
however, the difeafe has continued for feme time, and
the inflammatory fymptoms have very much abated,!
am of opinion, that by injections of moderate aftrin-
gency, or at lead of this gradually increafed, an end
may be fooner put to the difeafe than would other-
wife have happened ; and that a gleet, fo readily oc-
curring, may be generally prevented*.

MDCCL XXVII.

Befides the ufe of aftringent injections, it has been
common enough to employ thofe of a mercurial kind.
With refpecl to thefe, although I am convinced that

3 C 2 the

* The practice of ufing aftringent inje&ions is extremely com-
mon ; but, fas the author julUy obferves,) their ufe is frequently at-
tended with difagreeable confequences. In general they do harm
when ufed during the continuance of the inflammatory fymptoms,
or even too foon after thefe fymptoms have difappeared. If, how-
ever, (after the inflammatory fymptoms are overcome, and mercury
has been ufed for fix weeks or two months rn the manner defcrib^tl
in the note on article 1770,) the Tunning dill continues, we may
then have recotirfe to thefe aftringent injections. They may be made
of fugar of lead and white vitriol well diluted with water as in the
following :

$> Sacch. Saturn,

Vitriol, alb. a a 3^*«
Aq. font, Jfviii.
M. et cola per chartsm.

Half an ounce of this injeftion {lightly warmed may be thrown
up in the urethra twice a-day ; but if it produce any fmarting, it
ought to be diluted with more water,

Solutions of copper have alfo been ufed with advantage in thefe
cafes, but they are of fo corrofive a nature, as-. frequently to do harm,
if not very much diluted.

An imprudent or too frequent ufe of any thefe injections, efpeciaily
if they are too ftror.g or not flifficiently diluted, fometime's inflames
or even excoriates the urethra, and hence much mifchtef arifes. The
cautious practitioner rr.uft therefore never ufe them fo ilrong as to
produce much fmaiting.

388 PRACTICE

the infection producing gonorrhoea, and that produc-
ing chancres and fiphylis, are one and the fame ; yet
I apprehend, that in gonorrhoea mercury cannot be of
life by correcting the virulence of the infection ; and
therefore that it is not univerfally necefiary in this
difeafe. I am perfuaded, however, that mercury ap-
plied to the internal furface of the urethra, may be of
ufe in promoting the more full and free difcharge of
virulent matter from the mucous glands of it. Upon
this fuppofuion, I have frequently employed mercu-
rial injections ; and, as 1 judge, with advantage ;
thofe injections often bringing on fuch a (late of the
confidence and colour of the matter discharged, as we--
know ufually to precede its fpontaneous ceaiing. I
avoid triefe injections, however, in recent cafes, or
while much inflammation is iiill prefent ; but when
that inflammation has fomewhat abated, and the dif-
charge notwithftanding dill continues in a virulent
form, I employ mercurial injections freely. I employ
thofe only that contain mercury entirely in a liquid
form, and avoid thofe which may depofite an acrid
>.oweder in the urethra. That which I have found
in oft ufeful is a folution of the corrofive fublimate in
\vater; fo much diluted as not to cccaiion any violent
fniarting, but not fo much diluted as to give no fmarc-
ing at all. It is fcarce neceffary to add, that when
there is reafon to fufpect there are nice rations already
formed in the urethra, mercurial injections are not
only proper, but the only effectual remedy that can
be employed.

MDCCLXXVIII.

V/ith regard to the cure of gonorrhoea, I have only
one other remark to offer. As mofl of the fymptoms
urife from the irritation of a (limultis applied, the ef-
fects of this irritation may be often leaned by dimi-
nifhing the irritability of the fyilem ; and it is well
known, that the molt certain means of accompli (h ing

this

OF PHYSIC. 389

this is by employing opium. For that reafon, I con-
ilder the practice both of applying opium directly to
the urethra*, and of exhibiting it by the mouth, to
be extremely ufeful in moft cafes of gonorrhoea*

MDCCLXXIX.

After thus offering feme remarks with refpect to go-
norrhoea in general, I might proceed to conficier par-
ticularly the various fymptoms which ib frequently at-
tend it ; but it does not feern neceilary for me to at-
tempt this after the late publications of Dr. Foart
Simmons, and of Dr. Schwediaur, who have treated
the fubject fo fully, and with fa much difcernment
nnclikillj.

MDCCLXXXI.

1

* Opium may be very conveniently applied to the urethra by in-
jeclion ; and for this purpofe a diluted folution of opium in water
is preferable to a fpirituous or vinous folution. A grain of opium
ditTolved in an ounce of water, and the fohuion drained, may be in-
jected twice or thrice a-day ; and thirty or forty drops of laudanum
may be given every night at bed-time.

§ Asa fwelled tefiicle frequently attends a fupprefftrd (ronorrhcea,
it may be proper to give the young practitioner fame directions con-
cerning the management of it.

Sometimes without any other preceding fymptom, but generally
on a premature (topping of a gonorrhoea, a pain is felt in the fprr-
matic veffels and epididymis. The pair, continuing, the veiTels and
ep'ciidyrnis begin to fvvell, and the pain and f welling are foon com-
municated to the tefticle.

In thefe cafes, we mult confine the patient to his bed, bleeding
liim if the inflammatory diathefis appears to be univerfal ; but, if
not, three or four leeches may be applied to the inflamed part. A
brifk purge mud be given, for which purpofe an ounce of .Glauber's
Salt, with a large quantity of water, anfwcrs fufficienlly well. Gold
pledgets foaked in a folution of Sugar of Lead, ckicribed in the
note on article 267. muft be applied to the Scrotum, and then place
iupplied with frefh cold ones, as often as they grow warm by lying
on the parts. A warm poultice of bread and milk, muft be alfo ap-
plied to the glans penis or to the whole penis. The patient muft be
kept on aver) fpare diet, ufmg fot his drink cold water with a fcru-
jle of nitre in each pint of it. This regimen generally allays the
violence of the fymptoms, within twenty four hours ; but, it will
ke neccffary to continue the ufe of the cold pledgets and warm poul-

33o PRACTICE

MDCCLXXX.

The other form of the local affeclion of fiphylls, is
that of chancre. The ordinary appearance of this I
need not defcribe, it having been already fo often done.
Of the few remarks, I have to offer, the firft is, that 1
believe chancres never appear in any degree without
immediately communicating to the blood more or lefs
of the venereal poiibn ; for I have conftantly, when-
ever chancres has appeared, found, that unlefs mer-
cury was immediately given internally, fome fymp-
toms of a general fiphylis did certainly come on after-
wards ; and though the internal ufe of mercury fhould
prevent any fuch appearance, it is (till to be prefumed
that the poifon had been communicated, becaufe mer-
cury could act upon it in no other manner than as dif-
fufed in the fluids,

MDCCLXXXI.

It has been a queftion among pra&itioners, upoa
the fubjecl of chancres, Whether they may be imme-
diately healed up by applications made to the chancres,
or if they fhould be left open for fome time without
any fuch application ? It has been fuppofed, that the

ftidden

tice for three or fcmr days or longer, and to repeat the purge. After
the pain and fwellinghave been completely removed, the patient may
fit up, hut it will be prudent for him to ufe a fufpenfory bandage for
the fcrotum, as the 'weight of the tefticles, by ftretching fpermatics
cords will be apt to occafion the return of all the fymptoms.

Sometimes the gonorrhoea, if it has preceded the fvvellings of the
eptdidymis and telHcles, will be a^ain brought on ; but, it likewife
fometimes happens that, on difcuffing the tumor in the fcrotnm the
glands of the groin begin to be painful and to fweil. In thefc cnfes
we mull apply cold p'edgets to thefe glands as well as to the fcro-
tu.n ; and rub, at the fame time, fome ftrong mercurial ointment on
the infide of the thighs, in the courfe of the lymphatics going to
thefe glands ; and, if the penis be not inflamed, half a dram or a.
fcruple of mercurial ointment ought to be rubbed on the bafe of the
glans penis in the inllde of the prepuce.

Mich is the general method of treating cafes of this kind, and a
deat continuance of it fcldom fail of fuccefs.

OF PHYSIC.

fudden healing up of chancres might immediately
force into the blood a poifon, which might have been
excluded by being difcharged from the chancre.
This, however, is a iuppofitioii that is very doubtful ;
and, upon the other hand, I am certain, that the long-
er a chancre is kept open, the more poifon it perhaps
generates, and certainly fupplies it more copioufly to
the blood. And although the above-mentioned fuj>
pofnion were true, it will be cf little confequence, if
the internal ufe of mercury, which I judge neceffury
in every cafe of chancre, be immediately employed.
I have often feen very troublefome confequences fol-
low from allowing chancres to remain unhealed ; and
the fymptoms of general fiphylis have always feerned
to me to be more coniiderable and violent in propor-
tion as chancres had been fuffervd to remain longer
unhealed : They fhould always, therefore, be healed
as foon as poflible ; and that by the only very cffeclu-
al means, the application of mercurials to the chancre
itfelf. Thofe that are recent, and have not yet form-
ed any confiderable ulcer, may often be healed by the
common mercurial ointment ; but the mod powerful
means of healing them has appeared to me, to be the
application of red precipitate in a dry powder*.

MDGCLXXXIL

* Although chancres may be very fpeedily healed by red preci-
pitate alone, yet it will be ncceffary fomnimes to ufe anointment
made of the red precipitate and twice or thrice it's weight of frefh
hogs lard. The precipitate will by this means be more conftantly
kept OM the part. The practitiower, however, mult be cautious left
he ufe too great a quantity of precipitate, which, by it's corrofive
quality, fometimes iucreafes the ulcer it was meant to heal.

During the ufe of this application, it will be neceffary alfo to ufc
mercury either internally or externally, in the manner defcribcd in
the note on article 1770.

The application of the laps infernalis to chancres, comes recom-
mended 10 us on the authority of fume eminent practitioners. It
is however a dangerous application, and frequently produces ulcers
that arc extremely difficult to heal.

39* PRACTICE

MDCCLXXXII.

When, in confequence of chancres, Or of the other
circumftances above mentioned, by which it may hap-*
pen the venereal poifoa has been communicated to the
blood, it produces many different fymptoms in differ-*
ent parts of the body, not neceffary to be enumerated
and defcribed here, that having been already done by
many authors with great accuracy.
MDCCLXXXIII.

Whenever any of thofe fymptoms do in any degree
appear, or as foon as it is known that the circumftan-
ces which give occafion to the communication of the
venereal poifon has taken place, I hold the internal ufe
of mercury to be immediately neceffary; and I am well
perfu-aded, that mercury employed without delay, and
in fufficient quantity, will pretty certainly prevent the
fymptoms which would other wife have foon appeared^,
or will remove thofe that may have already discovered
themfelves. In both cafes, it will fecure the perfoit
from any future confequences of fiphylis from that in-
feel ion.

MDCCLXXXIV.

This advice for the early and full ufe of mercury, I
take to be the mod important that can be given with
refpectto the venereal difeafe ; And although I muft
admit that the virulence of the poifon may be greater
in one cafe than in another, and even that one confti-
tution may be more favourable than another to the
• violence of the difeafe ; yet I am thoroughly con-
vinced, that mod of the inftances which have occurred
of the violence and obflinacy of fiphylis have been
owing very entirely to the neglect of the early appli-
cation ef mercury*.

MBCCLXXXV.

* In a word, mercury is a certain fpecific for fiphylis, and a fare
antidote againit the venereal poifon * If it be propeily uied. it fel-
ciom fails of producing a cure ; and this cure will always be more

OF PHYSIC. 393

MDCCLXXXV.

Whatever other remedies * of fipbylis may be
known, or may hereafter be found out, I cannot pre-
tend to determine; but I am well perfuaded, that in
mo ft cafes mercury properly employed will prove a
very certain and effectual remedy. With refpect to
others that have been propofed, I ihall offer this remark
only, that I have found the decoction of the meze-
reon contribute to the healing of ulcers which feem-
cd to have refilled the power of mercury.
MDCCLXXXVL

Wkh regard to the many and various preparations
of mercury, I dp not think it neceflary to give any
enumeration of them here, as they are commonly ve-
ry well known, and have been lately well enumerated
by Dr. Schwediaur. The choice of them feeins to be
for the moil part a matter of indifference; as I believe
cures have been, arid ftill may be, effected by many
different preparations, if properly adminiitered. The
proper adminirtration§ feems to confift, i/2, In the
choofing thofe preparations which are the lead ready
to run off by (tool ; and therefore the applications ex-
ternally by unction are in many cafes the mod conve-
nient, 2^/jf, In employing the unction, or in giving*
a preparation of mercury internally* in fuch quantity
as may (how its feniible effects in the mouth* And
^dly, without carrying thefc effects to a greater length,
In the continuing the employment of mercury for fe-
veral weeks, or till the fymptoms of the difeafe fhali
have for feme lime entirely "difappeared. I fay no-

VOL. II. 3 I) thing

fpesdy, in proportion, as rnejycury has been ufcd In the earlier ftage
of the dtfeafe.

* We have no occafion tofeek for other remedies than mercury :
and the praftitioner \vho rifles his patient's health, and his own re-
putation, on the uncertain effects of other remedies* furdy de/ervca
reprchenfion.

§ Seethe notes OP. Article i

394

PRACTICE

thing of the regimen proper and neceffary for patients
during the employment of mercury, becaufe I prefume
it to be very well known.

MDCCLXXXVIL

Amongft the other preparations of mercury, I be-
lieve the corrofive fublimate has often been employed
with advantage : but I believe alfo, that it requires be-
ing continued for a longer time than is necefiary in
the employment of other preparations in the manner
above propofed ; and I fufpect it has often failed in
making a cure, becaufe employed while perfons were
at the fame time expofed to the tree air.
MDCCLXXXV1II.

Upon thefe points, and others relative to the admi-
niftration of mercury, and the cure of this difeafe, I
might offer feme particular remarks : but I believe
they are generally underflood ; and it is enough for
me to fay here, that if practitioners will attend, and
patients will fubmit, to the general rules given a
they will feldom fail of obtaining a certain and
cure of the difeafe.

C II A P. IIL

OF S C U R V Y.

MDCCLXXXIX.

THIS difeafe appears fo frequently, and the effects
of it are fo often fatal in fleets and armies, that
it has very properly engaged the particular attention
of phyficians. It is indeed furprifing that it had not
fooner attracted the efpecial notice both of flatefmeri
and'phyficianSj fo as to have produced thofe meafures

and

OF, PHYSIC. 395

and regulations that might prevent ihc havock which
it fo often occafions. Within thefe lad fifty years,
however, it has been fo much attended to and ftudied,
that we might fuppofe every circumftance relating to
it fo fully and exactly afcertained, as to render all fur-
ther labour upon the fubject fuperfluous. This per-
haps may be true ; but it appears to me, that there are
flill feveral circumftances, regarding the difeafe not
agreed upon among phyficians, as well as different opi-
nions formed, feme cf which may have a bad effect
upon the practice ; and this feems to me to be fo
much the caxre, that I hope I {hall be excufed in endea-
vouring here to Hate the facts as they appear to me
from the bed authorities, and to offer remarks upon
opinions which may influence the practice in the pre-
vention and cure of this difeafe.
MDCCXC.

With refpect to the phenomena of the difeafe, they
have now been fo fully obferved, and fo accurately
defcribed, thai there is no longer any doubt in difcern-
ing the difeafe when it is prefent, or in diftinguifhing
it from almoft every other aliment. In particular, it
feems now to be fully determined, that there is one
difeafe only, intitled to the appellation of Scurvy ;
that it is the fame upon the laud as upon the fea ; that
it is the fame in all climates and fcafons, as de-
pending every where upon nearly the fame caufes;
and that it is not at all diveifified, either in its pheno-
mena or its caufes, as had been imagined fom.e time
ago.

MDCCXCI.

The phenomena of icurvy, therefore, are not to be
defcribed here, as it has been fo fully and accurately
done elfe where ; and I fhall only endeavour to afcer-
tain thofe fads with refpect to the prevention and cuie
of the difeafe which feem not yet to be exactly a-
grecd upon. And, firft, with refpect to the antece-

3 I> 2- dents

P R A C T I C E

dents that may be coniidered as the remote cauies of
the difeafe.

MDCCXCII.

The mod remarkable circurnftances amongft the
antecedents of this difeafe is, that it has moft common-
ly happened to men living very much on faited meats ;
and whether it ever arife in any other circtimftances,
is extremely doubtful. Thefe meats are often in a
putrefcent ftate ; and to the circumftance of the long
continued ufe of animal food in a putrefcent and
ibmewhst indigeftive (late, the difeafe has been efpe-
cially attributed. Whether the circumftances of the
meat's being faited, has any effect in producing
the difeafe, other wile than by being rendered more
indigeftible, is a queftion that remains ftill in difpute.
MDGGXC1IL

It feerns to me, that the fait concurs in producing
the effecl ; for there is hardly any inftance of the dif-
eafe appearing unlefs where fait meats had been em-
ployed, and fcarcely an example where the long conti-
nued ufe of thefe did not produce it ; befides all which,
there are fome inftances where, by avoiding faited
meats, or by diminifhing the proportion ol them in di-
et, while other circumftances remained much the
lame, the difeafe was prevented from appearing. Fur-
ther, if it may be admitted as an argument upon this
fubjecl, I /hall hereafter endeavour to ihow, that the
large ufe of fait has a tendency to aggravate and in-
creafe the proximate caufe oficurvy.
MDCCXC1V.

It mud, however, be allowed, that the principal
circumftance in cauiing fcurvy, is the Jiving very much
and very long upon animal food, efpecially when in a
putrefcent ftate ; and the clear proof of this is, that a
quantity of frelli vegetable food will always certainly
prevent the difeafe,

MDCCXtV,

OF PHYSIC. 397

MDCCXCV.

While it has been held, that, in thofe circumftances
In which fcurvy is produced, the animal food employ-
ed was efpecially hurtful by its being of difficult digek
lion, this opinion has been attempted to be confirm-
ed, by obferving, that the reft of .the food employed
in the fame circumftances was alfo of difficult digefti-
on. This is ftippofed to be efpecially the cafe- of
unfermented farinacea which fo commonly makes a
part of the fea-diet. But I apprehend this opinion to
be very ill-founded ; for the unfermented jfarinacea,
which are in a great proportion the food of infants, of
women, and of the greater part of mankind, can hard-
ly be fuppofed to be food of difficult diueition : and
with refpect to the production of fcurvy, there are
facts which fhow, that unfermented farinacea, em-
ployed in large proportion, have had a conilderable
effect in preventing the difeafe.

MDCCXCVL

It has been imagined, that a certain impregnation of
the air upon the fea had an effect in producing fcurvy.
But it is altogether improbable : for the only impreg-
nations which could be fufpected, are thofe of inflam-
mable or mephitic air ; and it is now well known,
t hat thefe impregnations are much lefs in the air upon
the fea than in that upon the land ; beiides, there are
otherwife many proofs of the falubrity of the fea- air.
If, therefore, fea-air have any effect in producing
fcurvy, it mud be by its feniible qualities of cold or
nioiilure.

MDCCXCVII.

That cold has an effect in favouring the production
of fcurvy 5 is man if eft from hence, that the difeafe is
more frequent and more confidcrable in cold than in
warm climates and feafons ; and that even warm
ploathing has a confiderable effect in preventing ic.

Mbccxcvai.

Moifture may in general have an effect in favouring

the

PRACTICE

the production of fcurvy, where that of the atmofphcre
in which men are placed is very confiderable : but the
ordinary moiiture of the lea-air is far from being fuch.
Probably it is never confiderable, except in the cafe
of unufual rains; and even then it is perhaps by the
application of moiflure to the bodies of men in damp
cloathing only that it has any fhare in the produc-
tion of fcurvy. At the fame time, I believe, there
is no inflance of either cold or moiflure producing
fcurvy, without the concurrence of the faulty fea-
diet.

MDCCXCIX.

Under thofe circumftances which produce fcurvy, it
commonly feems to occur moft readily in the perfons
who are the leaft exercifed ; and it is therefore proba-
ble, that confinement and want of exercife may have a
great fhare in producing the difeafe.
MDCCC.

It appears that weakneft, in whatever manner occa-
fioned, is favourable to the production of fcurvy. It
is therefore probable, that unufual labour and fatigue
may often have fome fhare in bringing it on : and
upon the fame account, it is probable, that fadnefs and
ciefpondency may induce a weaknefs of the circula-
tion ; and thereby, as has been remarked, favourable
to the production of fcurvy.

MDCCCI.

It has alfo been obferved, that perfbns negligent
in keeping their fkin clean by warning and change ot
cloathing, are more liable than others to be affc&ed
with fcurvy.

MPCCCII.

Several of thefe caufes, now mentioned, concurring
together, feem to produce fcurvy ; but there is no pro-
per evidence that any one of them alone will produce
it, or that all the others uniting together will do it,
without the particular concurrence of the fea-diet.
Along with this, however, feveral of the other circum-
ftances

OF PHYSIC. 359

fiances mentioned have a great efFed: in producing it
iboner, and in a more considerable degree, than
would otherwife have happened from the diet alone.
MDCCCIII.

From this view of the remote caufes, it will readily
appear, that the prevention of the difeafe may in
fome meafure depend upon the avoiding of thofe cir-
cumftances which we have enumerated as contributing
to bring on the difeafe fooner than it would otherwife
come on. At the fame time, the only effectual means
will be, by avoiding the diet of falted meats ; at lead
by leflcning the proportion of thefe, and ufing meat
preferved othervvife than by fait ; by uiing in diet
any kind of efculent vegetable matter that can be ob-
tained ; and eipecially by ufing vegetable matters the
rnoft difpofed to acefcency, fuch as malt ; and by
drinking a large quantity of pure water.
MDCCCiV.

The cure of fcurvy feems now to be very well af-
certained ; and when the neceflary means can be ob-
tained, the difeafe is commonly removed very quick-
ly. The chief means is a food of frefh and fucculent
vegetables, and thofe almoft of any kind that are at
all efculent. Thofe molt immediately effectual are
the acid fruits, and, as being of the fame nature, all
fort of fermented liquor.

MDCCCV. <

The plants named alkaltfcent, fuch as thofe of the
garlic tribe and of the tetradynamiae*, arc dfo parti-
cularly

* The plants of thisclafs ought to be ufed in large quantities, and
raw. The more a&ive fpecies are, Horfe-radifh, Muftard, Water-
rrcfs, garden-crcfs, Scurvy grafs : The milder fpecits are, Hadi&es,
Turnips, Cabbages, Cauliflowers, Brocoll, &c.

To the above lift, may be added fome other antifcorbutics ofdif-
fereut clafies ; as Malt, Spinach, Beet, Carrots, Celery, Endive,
Lettuce, Afparagus, the young (hoots of Hops, Purfiain, with fe-
veral others. All thefe frefli vegetables muit be eaten in large quan-
tities ; they ought indeed to conllitute the patient's chief food, an'd
las drink may be aficfh infufion of malt.

400 P R A C T I C £

cularly ufeful in the cure of this difeafe; for, notwith-
ftanding their appellation, they in the firft part of
their fermentation undergo an afcency, and feern to
contain a great deal of acefcent matter. At the fame
time, they have generally in their compofition an
acrid matter that readily paries by urine, probably by
perfpiration ; and by promoting both excretions, arc
ufeful in the difeafe. It is probable, that fome plants
of the coniferous tribe, luch as the fpruce fir, and
other poiTcfled of a diuretic power, may iikewife be of
fome ufe.

MDCCCVI.

It is fufEciently probable, that milk of every kind,
and particularly its productions whey and butter-milk,
may prove a cure of this difeafe.
MDCCCVII.

It has been common in this difeafe to employ the
foflil acids ; but there is reafon to doubt if they be of
any fervice, and it is certain they are not effectual re-
medies. They can hardly be thrown in fuch quan-
tity as to be ufeful in antifeptics ; and as they do not
feem to enter into the compofition of the animal flu-
ids, and probably pafs off unchanged by the excreti-
ons, fo they can do little in changing the ftateof the
fluids.

MDCCCVUI.

The great debility which constantly attends fcurvy$
has naturally led phyficians to employ tonic and
flrengthening medicines, particularly the Peruvian
bark ; but the efficacy of it feems to me very doubt-
ful. It is furpriiing how foon the ufe of a vegetable
diet reftorcs tile ftrength of icorbutic perfons ; which
feems to (how that the preceding debility had depend-
ed upon the (late of the fluids ; and coniequently, till
the found (late of thefe can be restored, no tonic re-
medy can huve much effect : but as the Peruvian bark

has

O F P H Y S 1C. 4o"i

has little power in changing the (late of the fluids, fo
it can have little effecl in fcurvy.
MDCCCIX,

I fhall conclude rny obiervations upon the medi-
cines employed in (curvy, with remarking, that the
ufe of mercury is always maniieftiy hurtful.
MDCGCX.

After having obferved that both the prevention and
cure of this difeafe are now very well known, it may
feem unneceffary to enter into much difcuiTion con- •
cerning its proximate caufe : but as fuch difcuffions
can hardly be avoided, and as falfe opinions may iri
fome meafure corrupt the practice, I fhall venture to
fugged here what appears to me mod probable upon
the fubjecl:.

MDCCCXT.

Notwithstanding what has been afferted by fome
eminent perfons, I trufl to the concurring teltimony
of the mod part of the authors upon the fubjecl, that
in fcurvy the fluids fuffer a confiderable change.

From thefe authors we learn, that in the blood
drawn from the veins of perfons labouring under the
fcurvy, the crafHimentmn is different both in colour
and confidence from what it is in healthy perfons;
and that at the fame time the ferum is commonly
changed both in colour and tade. The excretions al-
fo, in fcorbutic perfons, ihow a change in the date of
the fluids. The breath is fetid ; the urine is always
high-coloured, and more acrid than ufual; and if that
acrid exfudation from the feet, which Dr. Hulme tak-s
notice of, happens efpeciaily in fcorbutic peifons, ic
will be a remarkable proof to the iame-purpofe. .Bu:
however this may be, there is evidence enough that
in fcurvy the natural date of the fluids is considerably
Changed. Further, I apprehend it may be confidently
prefurned from this, that the difeafe is brought on by
a particular noiirifUment introduced into the body, and

VOL. II. 7 E

402 PRACTICE

is as certainly cured by the taking in of a different di-
et. In the latter cafe, the diet ufed has no other evi-
dent operation, than that of giving a particular ftate
and condition to the fluids.

MDCCCXII:

Prefuming therefore, that the difeafe depends upcn
a particular condition of the fluids of the body, the
next fubjed of inquiry is. What that condition may
be?

With this view I muft obferve, that the animal
ceconomy has a lingular power of changing acefcent
aliments, in fuch a manner, as to render them much
more difpofed to putrefaction; and although, in a
living ftate, they hardly ever proceed to an actually
putrid Hate ; yet in man, whole aliment is of a mixed
kind, it is pretty certain, that if he were to live entire-
ly upon animal food, without a frequent fiipply of ve-
getable aliment, his fluids would advance further to-
wards putrefaction than is confident with health.

This advance towards putrefaction feems to coniift in
the production and evolution of a faline matter which
did not appear in the vegetable aliment, and could not
be produced or evolved in it, but by carrying on its
fermentation to a putrefactive ftate. That this faline
ftate is conftantly in fome meafure produced and evolv-
ed by the animal procefs, appears from this, that cer-
tain .excretions of faline matter are constantly made
from the human body, and are therefore prefumed ne-
ceflary to its health.

From all this, it may be readily underftood, how
the continual ufe of animal food, efpecially when al-
ready in a putrefcent ftate, without a mixture of vege-
table, may have the effect of carrying the animal
procefs too far, and particularly of producing and
evolving a larger proportion of faline matter. That
fuch a preternatural quantity of faline matter does ex-
lit in the blood of fcorbutic perfons, appears from

the

O E1 PHYSIC. 403

the (late of the fluids above-mentioned. It will be a
confirmation of all this to obferve, that every interrup-
tion of perfpiration, that is, the retention of faline
matter, contributes to the production of fcurvy ; and
this interruption is efpecially owing to the application
of cold, or to whatever elfe weakens the force of the
circulation, fuch as the neglect or want of excrcife,
fatigue, and defpondency of the mind. It deferves in-
deed to be remarked here, that one of the firft effects
of the fcurvy once induced, is very foon to occafion a
great debility of the fyftem, which occafions of courfe
a more rapid progrefs of the difeafe. How the Hate of
the fluids may induce fuch a debility is not well un-
derftood ; but that it does depend upon fuch a Hate
of the fluids, is rendered fufficienrly prefumable from
what has been faid above with regard to both the
cauies and the cure of fcurvy.

MDCCCXIII.

It is poflible that this debility may have a great (hare
in producing feveral of the phenomena of fcurvy ; but
a preternaturally faline, and confequently diflblved,
ftate of the blood, will account for them with more
probability; and I do not think it necefTary to perfons
who are at all accuftomed to reafon upon the animal
ceconomy, to explain this matter more fully. I have
only to add, that if my opinion in .fuppofing the prox-
imate caufe of fcurvy to be a preternaturally faline
ftate of the blood, be at all founded, it will be fuffi-
ciently obvious, that the throwing into the body along
with the aliment an unufual quantity of fait, may have
a great mare in producing the difeafe. Even fuppof-
iag fuch fait to fuffer no change in the animal body,
the effect of it may be cpnfiderable ; and this will be
rendered (till more probable, if it may be prefumed,
that all neutral ialts, coniifting of a fixed alkali, are;
changed in the animal body into an ammoniacal fait ;
which I apprehend, to be that efpecially prevailing in

3 E 2 fcurvy.

404

PRACTICE

fcurvy. If I be at all right in concluding, that meats-,
from being falted, contribute to the production of (cur-
vy, it will readily appear, how dangerous it may be to
admit the conclufion from another theory, that they
are perfectly innocent.

MDCCCXIV.

Having thus endeavoured to explain what relates
to the cure of fcurvy in general, I judge it proper to
leave to other authors, what relates to the manage-
ment of thofe fymptoms which require a particular
treatment.

CHAP. IV.
O !«' J iA U N D I C E.

MDCCCXV.

I HAVE here palled over feveral of the titles in my
nofology, becaufe they are ^iftafes not of this iflanci.
In thefe, therefore, I have no experience ; and with-
out that, the compiling from other writers is always
extremely fallacious, for thefe reafons I omit them ;
and mail now only offer fome remarks upon thefubjecl
of jaundice, the lafc in order that I can poilibly intro-
duce in my courfe of Lectures.

MDCCCXVI.

The jaundice confifts in a yellow colour of the fkin
over the whole body, and particularly of the adnataof
the eyes. This yellow colour may occur from differ-
ent caufes : but in the jaundice, hereafter to be more
exactly chara&erifed, I judge it to depend upon a
quantity of bile prefcnt in the mafs of blood ; and

which,'

OF PHYSIC. 4©5

which, thrown out upon the furface, gives its own pra_-
per colour to the {kin and eyes.

MDCCCXVII.

That the difeafe depends upon this we know parti-
cularly and certainly from the caufes by which it is
produced. In order to explain thefe, I muft obferve,
that bile does not exift in its proper form in the mafs
of blood, and cannot appear in this form till it has pa.,1-
ed the fecretory organ of the liver. The bile, there-
fore, cannot appear in the mafs of blood, or upon the
furface of the body, that is, produce jaundice from any
interruption of its lecretion ; and accordingly, if jaun-
dice does appear, it muft be in confequence of the
bile, after it had been fcccrned, being again taken into
the blood-vcffels.

This may happen in two ways; either by an inter-
ruption of its excretion, that is, of its pafTage into the
duodenum, which by accumulating it in the biliary
veflels, may giveoccafion to its pairing again into the
blood-veifels ; or it may pafs into thefe, by its being
abforbed from the alimentary canal, when it happens
to be accumulated therein an unufual quantity. How
far the latter caufe can take place, or in what circurn-
ilances it does occur, I cannot clearly afcertain, and I
apprehend that jaundice is feldom produced in that
manner.

MDGCCXVIII.

The former caufe of flopped excretion^ may be un-
deritood more clearly ; and we have very certain proof
of its being the ordinary, and indeed the almoft univer-
fal^ caufe of this difeafe. Upon this fubjecl it will be
obvious, that the interrupted excretion of the bile
mud depend upon an ob(tru<5tiori of the duclus com-
munis choledocbus ; the mod common caufe of which
is a biliary concretion formed in the gall-bladder, and
from thence fallen down into the duclus cornmunis,
it being at the fame time of fuch a fize as not to pafs

readily

4o5 P R A C T I C E

readily through that dud into the duodenum.
dud may like wife be obflruded by a fpafmodic con-
Itridion affeding it : and fuch fpafm may happen, ei-
ther in the dud itfeif, which we fuppofe to be contrac-
tile ; or in the duodenum preiiing the fides of the dud;
clofe together ; or, laitly, the dud may be ohftruded
by a tumour comprefling it, and that arifyig either in
the coats of the dud itfeif, or in any of the neighbour-
ing parts that are, or may come to be, contiguous to

MDCCCX1X.

When fuch obftrtidion happens, the fecreted bile
mil ft be accumulated in tine biliary duds ; and from
thence it may either be abforbed and carried by the
lymphatics into the blood-verTels, or it may regurgitate
in the duds themfeives, and pafs from them directly
into the afcending cava. In either way, it comes to be
ciiiiuied in the mafs of blood ; and from thence may
pafs by every exhalant verTel, and produce the difeafe
in queftion.

MDCCCXX.

I have thus fhortly explained the ordinary prod tic*
tion of jaundice : but it mutt be obferved further,
that it is at all times accompanied with certain other
fymptoms, fuch as a whitencfs of the faces a]vin(p^
which we readily account for from the abfence of bile
in the inteftines ; and generally, aif®, with a certain
confidence of the faeces, the caufe of which is not fo
eafy to explain. The difeafe is always accompanied
alfo with urine of a yellow colour, or at Jeaft with urine
that tinges a linen cloth with a yellow colour. Thcfe
are conftantly attending fymptoms; and though not
always, yet there is commonly, a pain felt in the epiga-
ilriurn, correfpcnding, as we fuppofe, to the feat of the
dudus comraunis. This pain is often accompanied
with vomiting ; and even when the pain is not confi-
derable, a vomiting fometimes occurs. In fome cafes,

when

OF PHYSIC. 467

when the pain is confiderable, the pulfe becomes fre-
quent, full, and hard, and fome other fymptoms of py-
re xia appear.

MDCCCXXI.

When the jaundice is occalioned by tumours of the
neighbouring parts compreffing the biliary duel:, I be-
lieve the difeafe can very feldom be cured. That fuch
is the caufe of jaundice, may with fome probability be
fuppofed, when it has come on in confequenee of other
difeafes which had fublided long before, and more espe-
cially fuch as had been attended with fymptoms of ob-
itrucled vifcera. Even when the jaundice has fubfi fl-
ed long without any intermiflion, and without any
pain in the epigaftrium, an external compreilion is to
be fufpeded.

MDCCCXXII.

In fuch circumftancesj I confider the difeafe as in-
curable ; and it is almofl only when the difeafe is oc-
cafioned by biliary concretions obftru&ing the biliary
duel, that we may commonly expe£k relief, and that
our art may contribute to the obtaining it. Such
cafes may be generally known by the difeafe frequent-
ly difappea'ring and returning again ; by our finding,
after the former accident, biliary concretions ambngft
the fasces ; and by the difeafe being frequently accom-
panied with pain of the epigastrium, and with vomit-
ings ariiing from fuch pain.

MDCCCXXIIL

In thefe cafes, we know of no certain and immedi-
ate means of expediting th/j paffage of ihe biliary con-
cretions. This is generally a work of time depending
upon the gradual dilatation of the biliary duel ; and it
is furpiiiing to obfcrve, from the iize of the (tones
which fometimes pafs through, what dilatation the
duel will admit of. It proceeds, however, falter or
flower upon different occafions ; and therefore the
jaundice, after a various duration, often ceafes fudden-

P R A C T I C E

ly and fpontaneoufly. It is this which has given rife
to the belief, that the jaundice has been cured by
fuch a number and fuch a variety of different reme-
dies. Many of theie, however, arc perfectly inert, and
many others of them fuch as cannot be fuppofed to
have any eifect in expediting the.paflage of a biliary
concretion. 1 ihall here, therefore, take no notice of
the numerous remedies of jaundice mentioned by the
writers on the Materia Medica, or even of thofe to be
found in practical authors ; but fnall confine myfelf to
the mention of thole that may with probability be fup-
pofed to favour the paflage of the concretion, or re-
move the obftacles to it which may occur.
MDCCCXXIV.

In the treatment of this difeafe, it is in the firft place,
to be attended to, that as the diftenfion of the biliaiy
duel, by a hard mafs that does not eafily pafs through
it, may excite inflammation there ; fo, in perfons of
tolerable vigour, blood-letting may be an ufeful pre-
caution ; and when much pain, together with any
degree of pyrexia, occurs, it becomes an abfolutely
necelfary remedy. In fome inftances of jaundice ac-
companied with thefe fymptoms, I have found the
blood drawn covered with an inflammatory cruft as
thick as in caies of pneumonia.

MDCCCXXV.

There is no means of puihing forward a biliary con-
cretion that is more probable than the action of vo-
•miting ; which, by compreiling the whole abdominal
vifcera, and particularly the fall and diftended gall-
bladder and biliary veifels, may contribute, fqmet'imes
gently enough, to the dilatation of the biliary duel.
Accordingly vomiting has often been found ufefui for
this purpofe ; but at the fame time it is poilible, that
the torce exerted in the ad of vomiting may be too
violent, and therefore gentle vomits ought only to he
employed. And either when, by the long continu-
ance

OF PHYSIC. 409

ance of the jaundice, it may be fufpe&ecl that the iize
of the concretion then palling is large ; or more efpe-
cially when pain attending the difeafe gives apprehen-
fion of inflammation, it may be prudent to avoid vo-
miting altogether.

MDCCCXXVI.

It has been ufual in the jaundice to employ purga-
tives ; and it is poffible that the aclion of the intef-
tines may excite the adlion of the biliary duels, and
thus favour the expuliion of the biliary concretion :
but this, I think, cannot be of much effecl: ; and the
attempting it by the frequent ufe of purgatives, may
otherwife hurt the patient. For this reafon I appre-
hend, that purgatives can never be proper^ excepting
when there is a flow and bound belly*.
MDCCCXXVII.

As the relaxation of the ikin contributes to relax
the whole fyitem, and particularly to relieve the con-
ftri&ion of fubjacent parts ; fo, when the jaundice is
attended with pain, fomentations of the epigaftriurn
may be of fervjce.

MDCCCXXVIII.

As the folids of the living body are very flexible and
yielding; fo it is probable, that biliary concretions
would in many cafes find the biliary duel readily ad-
mit of fnch dilatation as to render their pafTage
through it eafy, were it not that the diftenfion occa-
fions a preternatural fpafmodic contraction of the parts
below. Upon this account, opium is often of great
benefit in jaundice ; and the .benefit refulting from its

VOL. II. 3 F ufe,

The good effe&s of purgatives, in removing biliary concre-
tions in the du£, are fufficicntly apparent by daily experience. It
is true, indeed, that all purgatives have not this effe&, cfpecially
fuch as are of a gentle and flow operation. The draflic purges, how-
ever, whofe a£tion is both brifk, and of long continuance, have fre-
quently been attended with good effefts. Some formula: of thefe
bnik draftics have been defcribed in the notes on article 168-?.

4io PRACTICE

ufe, proves fufficiently the truth of the theory upon
which the ufmg of it has been f. unded.

MDCCCXX1X.

It were much to be wiflied, that a folvent of biliary
concretions, which might be applied to them in the
gall-bladder or biliary dudfo, was difcovered; but none
fuch, fo far as I know, has yet been found ; and the
employment of foap in this difeafe, I confider as a
frivolous attempt. Dr. White of York has found a
folvent of biliary concretions when thefe are out of
the body ; but there is not the leail probability that
it could reach them while lodged within.

INDEX.

INDEX

TO THE TWO VOLUMES,

N. B. Tfce Figures refer to the number of Paragraphs,

ABSCESS, 250

ABSCESSES and ULCERS, the caufes of their dif-
ferent ftates 254
ACIDS, employed in fever 134
refrigerant in fever ib,
ACTION of the heart and arteries, how increafed for pre-
venting the recurrences of the paroxyfms of in-

termitting fever
ADYNAM^E
AMENORRHOEA,

from retention,

when occurring
fymptoms of
caufes of
cure of

230
1171

9.95
996
998

999

1000 2

1CO2 — 6
A ME-

i N r>

AMENORRHOEA from fnppreffion,

when, occurring
fymptoms of
caufes of
cure of

10OO

1010
1008 — 9

1011 — 12

AMENTIA ,598

ANASARCA, i668

the character of ib.

phenomena of !668 — 73

cure of X674 — 96

diftinguifhed frorn. Leucophlegmatia 1669

ST. ANTHONY'S FIRE. See Erythema.

ANTIMONIAL EMETICS, employed in fevers 181

their different kinds ib.

the cidminiftration of them in

fevers 183 — 6

ANTIPHLOGISTIC REGIMEN, 129

how conducted 130
when employed in inter-
mittent f eve is 2,34
ANTISPASMODICS employed in fevers
APHTHA

APOPLEXY

diftinguifhed from pslff
diftinguifhed from fyncope
predifponent caufes of
exciting caufes of
proximate caufe of
SEROSA, proximate caufe of

prognoftic

frequently ending in hemiplegia

prevention of

152 — 187

733
1094

ib.

ib.

109,5

1098 — 1115 — 16-

1100 — 21
1114

1122 — 2J
1 1 22
1124

whether fanguine or ferous, ftimulants

hurtful in it

from powers that deftroy the mobility

of the nervous power

cure of
APYREXIA
ASCITES,

character of
its various feat
the phenomena of

1136—37

1138

24
1709

ib.

1710 — ii
1712—13

ASCITSS,

INDEX. iS

ASCITES, its particular feat difficultly afcertained 1714

the cure of *7*5 — 17

ASTHMA, 1373

phenomena of 1 375

exciting caufes of 1381

proximate caufe of *3$4

diftinguifhed from other kinds of dyfpnoea 1385
ASTHMA, fometimes occalions the phthifis pulrnonalis 1386
frequently ends in hydrothoiax ib*

feldom entirely cured ib.

ASTRINGENTS, employed in intermittent fevers 231

joined with aromatics, employed in in-
termittent fevers ib,
joined with bitters, employed in inter-
mittent fevers ib.
ATRABILIS 1029
AT.ROPHIA, ab alvi fluxu 1607
debilium 1606
inanitorum- . 1607
infantilis ^oj
laclantium ib.
lateralis 1606 — it
a leucorrhoea, 607
nervofa, 606
nutricum, 607
a ptyalifma, ib.
rachitica, 605
fenilis, 1606 — n
AURA EPILEPTICA, J3°6

B.

EITTEHS employed in intermittent fevers, 231

joined with aftringents, employed in intermittents, i^.
BLISTERINGJ its efFecis, 189 — 197

its mode of operation in the cure of

fevers, 190 — 194

when to be employed in fevers, 195

where to be applied in fevers, n^6

BLOOD-LETTING, the employment of it in fevers, 138—143

the circumftances directing its ufe in fevers, 142

the adminiftration of it in fevers, 143

when employed in intermittent fevers, 234

C.

CACHEXIES, character of the clafs, 1,599

CACHEXY,

rr INDEX.

CACHEXY, the term, how applied by authors,

CALCULUS RENALIS, 429

CALX NITRATA ANTIMONII, its ufe in fevers, 183—185

CANINE MADNESS, 3525

the cure of, 1525 — 1527

CARDIALGIA, 1427

CARDITIS, 383

of the chronic kind, ib.

CARUS, l°94

CATAPHORA, ib.

CATARRH, I04g

predifpofition to, 1047

fymptoms of, ,048

remote caufes of, f©47

proximate caufe of, 1057

cure of, i°65

produces phthifis, 10^5

paffes into pneumonia, 10,54

produces a peripneumonia notha, 1056

CONTAGIOUS, 1062

CATARRHUS SUFFOCATIVUS, 376

CHANCRE, method of treating, 1781

CHICKEN-POX, 631

how diftinguifhed from fmall-pox, 632

CHINCOUGH, 1402

contagious, ibp

frequently accompained with fever, 1410

phenomena, 1404

prognoftic in, 1413

cure of, 1414

CHLOROSIS, 9^5

CHOLERA, 1453

fymptoms of, X4<53 — 5&

remote caufes of, *4£8 — So

proximate caufes of, 14 54

cure of, 1462 — 64

CHOREA, 1347

phenomena, 1347 — 53

cure of, 1354

CHRONIC weaknefs, 1191

COELIACA, 1493

COLD,

INDEX.

COLD, its operations,
abfolutc,
•relative,

its general effects on the human body,

its morbid effects, ^2

moderates the viol«nce of reaction in fever, 133

its tonic power, how to be employed in fevers, 20,5

COLD drink, an ufeful tonic in fevers, 206

the limitation of its ufe in fevers, 207

air applied in fevers, 208

water applied to the furface of the body in fevers, 205 — 209

COLIC, 1435

the fymptoms of, 1435 — 38

proximate caufe of, 1439

cure of, M41

Devonfhire. See Colic ofPoitou.

COLIC, of Poitou, 1451

cure of, *452

COMA, J093-

CoMATA, I093

CONTAGIONS, 78

their fuppofcd variety, 79

CONVULSIONS, 1253

CORPULENCY, 1621

CYNANCHE, 300

MALIGNA,

PAROTIBEA,

PHARYNGEA, 33 1

TONSILLARIS, 301

TRACHEALIS, 318

as affecting infants, 322 — 329

the cure of it, 330

CYSTITIS, 431

D.

DAYS critical, in fevers, 107 — 124

non-critical, 113

DEATH, the caufes of, in general, .100

the direft caufes of, ib.

the indirect caufes of, ib.

the caufes of it in fever, 101

DEBILITY, infcvers, the fymptoms of, 104

DEBILITY,

vi INDEX.

DEBILITY, how obviated, 203

DELIRIUM, in general, explained, 1<529 — 50

in fever, of two kinds, 45

or INSANITY without fever, 1,550 — 57

DIABETES, 1504

fymptoms of, 15°4 — 9

remote caufe of, I5°8

proximate caufe of, 15 10 — 12

cure of, 1,513

DI^ITA AQUEA, 1,57

DIARRHOEA, 1465

DIARRHOEA, diftinguifhed from dyfentery, 1466

diftinguifhed from cholera, 1i"7

proximate caufe of, X4O^

remote caufes of, M71 — 93

cure of, 2494"~"15ca

BILIOSA, 1480

COLLIQUATIVE, I^Ol

MUCOSA, 1488

DIATHESIS FHLOGXSTICA, 62 — 247

how removed, 260

DILUENTS, their ufe in fevers, 154 — 158

DISEASES, the diftinguifliing of them, how attained, 2

the prevention of them, on what founded, 3

the cure of them, on what founded, 4

DROPSIES, 1645

in general, the caufe of them, 1646
of the breaft. See Hydrothorax.
of the lower belly. See Af cites.

DYSENTERY, 1067
contagions, JO75
remote caufes of, 1272
proximate caufe of, I077
cure of, 1 08©
ufe of mild cathartics to be frequently repeat-
ed in it, ib.
rhubarb improper in it, ib»
DYSENTERIA ALBA, 1070
DYSMENORHOEA, 1014
DYSPEPSIA, JI9°.'
re m o tc ca ufes of, 1 1 9 $

DYSPEPSIA,

INDEX, vii

DYSPEPSIA, proximate caufe of 1193

cure of 1201

flatulence in it, cure of 1221

heart-burn in it, cure of ib.

pains of (lomach in it, cure of ib.

vomiting in it, cure of ib.

DYSPNOEA, 1365

E.

EFFLUVIA, human 85

from marines ib.

EMACIATIONS, 1600

caufes of 1602 — 18

cure of 1619

EMANSIO. MENSIUM 998

JLMETICS, failed to the cure of fevers 174

their effecls 176—180

a means of removing fpafm I/O

the adminiftration of, in fevers 175

their ufe in intermittent fevers. 5230 — 233

EMPROSTHOTONOS, 1267

ENTERITIS, 404

phlegmonic or erythematiQ ib,

caufes of 407

rure of 409

EPILEPST, 128

phenomena of 1283

pioximate caufes of 1284
remote caufes of
predifponent caufes of
fympatnic,

cure of 1317

idiopathic, *3i6

cure of. 1310,

EPISTAXES, 806

the caufes of it 808

the various circumftances of 807 — 818

the management and cure of 819 — 8 2 9.

ERYSIPELAS, 274

of the face 708

fymptoms of 705 — 708,

prpgnofis of 706

% ERYSIPELAS,,

via INDEX.

ERYSIPELAS, proximate caufe of 69?

cure of 708 — 711

phlegmonodes in different parts of the body 712

attending putrid fever 7*3

ERYTHEMA, 274

EXANTHEMATA, 585

EXERCISE, ufeful in intermittent fevers 23*

F.

r

FAINTING See Syncope. 1171

FATUITY, 1529

FEAR, a remote caufe of fever 97

FEVER, H

ilri£lly fo called, the chara&er of 8 — 32

phenomena of

remote caufes of, are qfafec?ative nature 36

proximate caufe of 33
atony of the extreme veiTels, a principal circum-

ilance in the proximate caufe of it 43 — 44
fpafm, a principal part in the proximate caufe of it 46

general do&rine of 46

the caufes of death in it 101

the prognofis of QQ

indications of cure in 126

differences of 53

continent 28

continued 27

inflammatory 67
miliary. See Millar y Fever*

nervous 67

bilious 71
fcarlet. See Scarlet Fever.

putrid 7 2

pamed fynocha 67

fynochus 69

typhus ' 67

heaic, * 74

intermittent, the paroxyfms of, defcribed 10

the cold flage of n

FEVER.

INDEX.

FEVER, intermittent, the hot ftage of

the fweating ftage of

of a tertian period

of a quartan period

of a quotidian period

caufed by marfh effluvia

bile not the caufe of it

cure of

its paroxjfms, how prevented

attended withphlogiftic diathefis

intermittent, attended with congeftion
in the abdominial vifcera

remittent j

FLUXES, without fever. See Profluvia.
FLUOR ALBUS. See Lcucorrlcta.
FOMENTATION of the lower extremities, its ufein fevers
FOMITES of contagion
FUNCTIONS intellectual, diforders of 1,528—29

It

ib.

25

ib.

ib.

84

51

228

229

234

234
26

199
82

G.

GANGRENE of inflamed parts, the caufe of
marks of the tendency to
marks of its having come on
GASTRITIS,

phlegmonic or erythematic
phlegmonic, the feat of

the fymptoms of
thecaufes of
the cure of

erythematic, how difcovered
the feat of
the cure of
GASTRODYNIA,
GLEET,
GONORRHOEA,

phenomena of
cure of
GOUT, the character of

a hereditary difeafe
diftinguiflied from rheumatifm
b 2

25<5~ 256

257

ib.

ib.

-§5

385

1769

1765

65 — 69

1770 — 78

492

500

526

GOUT,

X INDEX.

GOUT, predifponent caufes of 49*— r'63

occaiional caufes of 5 ' -505

proximate caafe of 5 -/ — ^33

not a morbific matter / 29

Regular, delcribed ,506 — ^18

pathology of 533

cure of 537—573

no efFe&ual or fnfe remedy yet found

for the cure of it 539

•medicines employed for it 556

whether it can be radically cured 540
treatment in the intervals of paroxyfms 542

treatment in the time of paroxyfms 560

regimen during the paroxyfms 561

external applications, how far fafe 568 — 569
blood-letting in the intervals of paroxyfms S53

> — in the time of paroxyfms ,563

coftivenefs hurtful 559

laxatives to be employed ib.

effeas of alkalines 553

effects of Portland powder 55 7

irregular <5i&

Atonic, 574— 399

pathology of 534

cure of 580— 58*

Retrocedent, 522

pathology of 535

cure of 580—582

GOUT, Mi/placed, 523

pathology of 536

cure of 583— <584

Tranjlated, two particular cafes of 525,

H.

It JEM ATE ME S 1ST, 1O17

arterial and venous 1027
from obilrufted menflruation
from fuppreiTion of the hemorrhoidal flux
from compreilion of the vafa brevia by the

fpleen

from obfhuaion of the liver 1028

INDEX.

1033

idiopathic, improbable *°33 — 34

calculofa IO3^

cure of ic>3&

violenta 1O39
from fuppreffion of accuftomed difcharges 1041

putrida 1O43

fpuria et lateritia 1044

HUEMIPLEGIA, 1140

caufes of 1141

frequently occafioned by apoplexy 114^

frequently alternates with apoplexy J144

cure of 1152

ftimulants, of ambiguous ufe in 1160

flimulants, external in 116*

HEMOPTYSIS,

the fymptoms of 838 — 840
the caufes of 760 — 763 — 830 — 836
how diflinguifhecl from ether fpiitings of

blood 841 — 45

cure of 846 — 52

H^EMORRHAGIA UTERI, 966

HEMORRJAGY,

active or paflive 735

character of 736

arterial 744

venous 76^
the caufes of the different fpecies appearing at

different periods of life 7,50 — 773

the general phenomena of 738 — 743

the remote caufes of 774

cure of 776

whether to be attempted by art 776 — 81

prevention of the firfl attacks, or of the

recurrence of 782 — 789

treatment of when prefent 789 — 805

fymptomatic IO15

H/EMORRHOIDES VESICLE 1042

H&MORRHOIS,

external and internal 925

phenomena of 925 — 931

nature of the tumours 932

HJEMORRHOIS,

zli INDEX.

HJEMORRHOIS, caufes of 933 —

acquire a connection with the fyttem ^43 — 944-

particularly with the floraach 946

cure of 947 — 965

HEPATIRRHOEA, 148;

HEPATITIS, 412

acute and chronic ib.

acute, the fymptoms of 413 — 41^

combined with pneumonic inflammation 416

remote caufes of it ib.

feat of 418

various exit of pus produced in 421

cure of 422

chronic, the feat of 418

how difcovered 423

HOOPING-COUGH. See Chincough. 1402

HORROR, impreflion of, employed in intermittent fevers 23 1

HUMAN effluvia the caufe of fever $i

body, its temperature 88

body has a generating h'eat ib.

HYDROPHOBIA, 1525

HYDROTHORAX, 1697

where feated *6g8

fymptoms of f - 1701 — 03

often combined with universal dropfy 1704

proximate caufe of 1706

cure of 17°7 — c8

paracentefis in it, when proper 1708

HYPERCATHARSIS, 1477

HYPOCHONDRASIS, 1222

phenomena of ib.

diilinguiihed from dyfpepfia 1226

proximate caufe of 1230

cure of J232

treatment of the mind in 1244

HYSTERIA, 1514

fymptoms of *5r5 — 1&

paroxyfm or fit defcribed ib.

rarely appears in males i^1/

how diftinguiilied from hypochondriafis 1,518 — 19

proximate caufe of 1522

analogy between and epilepfy 1,5*3

HYSTERIA,

J N D E X. si

HYSTERIA, cure of 2524

Kbidinofa *5?7
HYSTERIC difeafe. See EyJIeria.

I.

JAMES'S powder, its ufe in fever 183
JAUNDICE, 1815—16
caufes of 1816—21
cure of 1823 — 29
ICTERUS. ^t'Juujidice.
ILIAC paffion. See Ileus.

ILEUS, M37

IM FETIGINES, J737

character of the order ib.
INDIGESTION. See Dyfpepfia*

INFLAMMATION, the phenomena of 235

internal the marks of 236

the flate of the blood in 237

the proximate caufe of 239
not depending upon alentor of the blood 241
fpafm. the proximate caufe of 243 — 248

terminated by refolution 2/j^

by fuppuration 250

by gangrene PJ5

jay fcirrhus 258

by effufion 259

l>y blifters 260

by exfudations 261

the remote caufes of 262

the cure of in general 264

by refolution ib.
when tending to fuppuration 268 — 70

when tending to gangrene 271

its general divilions 273

more ftri&ly cutaneous 274
of the bladder. • See Cyjlitis.
of the brain. See Phrenitis.
of the heart. See Carditis.
of the inteftines. See Enteritis.
of the kidneys. See Nephritis.
of the liver. See Hepatitis.

INFLAMMATION,

xiv [INDEX,

INFLAMMATION, of the lungs. See Pneumonia

of the pericardium. See Pericarditis,
of the peritonaeum. See Peritonitis.
of the fpleen. See Splenitis.
of the flomach. See Go/Iritis.

of the uterus 432

INSANITY, 1535
caufes of *55°— 57

of different fpecies 1557

partial and general difference of X575
INTEMPERANCE IN DRINKING, a remote caufe of fever 97

INTERMISSION OF FEVER, 24

INTERVAL OF FEVER, 124

JNTUMESCENTIJE, 1620

character o£ the order ib.

K.

KING'S EVIL. See Scroplula

L.

LEUCOFHLEGMATIA. 1669

LEUCORRHOEA, 985

character of 986
appearance of the matter discharged in 987 — 992

the caufes of 9^

the effeas of 99°

the cure of 993

LETHARGUS, 1094

LIENTERY,

LOOSENESS. See Diarrhcex.

M,

MADNESS. See Mania^

CANINE. See Canine.
MANIA,

the fymptoms of

the remote caufes of ,

the treatment of I562 — 74

MANIAC

INDEX. xv

MANIA, occurring in fanguine temperaments

in fanguine temperaments, cure of 1577

MARCORES, 1600

MARSH EFFLUVIA, a caufe of fever 84

MEASLES, 633

the fjmptoms of 637 — 642

the nature of 644

cure of 645 — 650

of a putrid kind 634

MEDICINE, the inftitution of 4

MELJENA, 1017

MELANCHOLIA, 1^75

how diflinguimed from hypochon-

driafis, 1,387— 88

the character of 1,582 — 89

the proximate caufe of I59°

the treatment of 1592 — 97

MELANCHOLIC TEMPERAMENT, I23°

MELANCHOLY. See Melancholia.

MENORRHAGIA, 966

aclive or paffive ib.

when a difeafe 968 — 75

effe&s of 972

proximate caufe of 977

remote caufes of 97$

cure of 980

MENSES, immoderate flow of them. See Menorrbagia.

METALLIC TONICS, employed in intermittent fevers 231

SALTS, refrigerant 136

METEORISMUS, 1633

MIASMATA, 78

MILIARY FEVER,

the general hiltory of 714 — 715

MILIARY FEVER, of two kinds, red and white 716

» white, the fjmptoms of 717 — 719

the cure of 720

MORE us COELIACUS, « 1493

MUCOSUS, .1070

NIGER, *O2e

N.

NEPHRITIS, 426

the fymptoms of ib.

NEPHRITIS,

*vi I N D E X.

NEPHRITIS,

the remote caufes of 427

the cure of 430
NERVOUS DISEASES. See Neurofes.

NEUROSES, 1090

NEUTRAL SALTS, diaphoretic in fevers i^p — 161

refrigerant in feverfr 135
NOSOLOGY, Methodical

O.

OBESITY, when a difeafe 1621

ONEIRODYNIA, 1^98

OPHTHALMIA, 278

membranarum ib.

its different degrees 279—280

its remote caufes ib.

the cure of 288 — 290

tarfr 278

the cure of 288 — 290

OPIATES, employed in the hot ftage of intermittent fevers 233

in the interval of intermittent fevers 23 1
OPISTHOTONOS. See 'Tetanus.

P.

PALPITATION of*the heart 1355

the phenomena of ib.

the caufes of *356

the cure of J3^3

PALSY, 1140

diftinguifhed from apoplexj Io94

caufes of 1141

PARACENTESIS in afcites, when to be attempted 1717

in hydrothorax, when proper 1708

PARAPHRENITIS, 343

PAROXYSM of intermittent fever, the recurrence, how to ^

be prevented 732

PEMPHIGUS, 229

PERICARDITIS, 383

PERIPNEUMONIA NoTHA, 376

fymptoms of 379

pathology of 3'^°

the cure of 381 — 382

fome of the fymptoms explained 350

PERIFNEUMONY, 242

PERITONITIS,

N D

PERITONITIS,

PERUVIAN BARK, not a fpecific
its tonic power
when proper in fever
how moft effectually employed
the adminiftration of, in intermittent fevers
the tonic chiefly employed in intermittent fevers

PETECHIA,

384
213

214

215

216

23*

ib.
734

PHLEGMON,

PHRENITIS,

the character of
the remote caufes of
the cure of

PHRENSY. See Pbrenitis.
PHYSIC, the practice of, how taught

the theory of, how to be employed
PHYSCONIA,

PHTHISIS PULMONALIS, the general character of
always with an ulceration of the lungs
the pus coughed up, how diftinguimed

from mucus

accompanied with he&ic fever
the various caufes of it
from hsemoptyfis
from pneumonia
from catarrh,
from aft h ma
from tubercles

from calcareous matter in the lungs
if contagious

from tubercles, fymptoms of
its different duration
the prognofis in
the cure of

the treatment of when ariling from tu-
bercles

the palliation of fymptoms
PLAGUE,

the general character of
phenomena of
principal fymptoms of

c 2

274
291

293
294

295—299

171
8^53

856
857
862

864 — 865

866 — 869

870 — 873

875

876 — 882
884

889

896

$97

899 — 924'

906 — 921
922 — 924

665

ib.

667

PLAGUE,

xvii INDEX.

PLAGUE, proximate caufe of 668

prevention of 670 — 68^

cure of 686 — 695

PLEURISY, 341

PLEUROSTHOTONOS. See tetanus.

PNEUMONIA, or PNEUMONIC INFLAMMATION, 334

general fymptoms of 335 — 339

feat of 340 — 344

prognofis of 352 — 360

cure of 361
the management of blood-letting in the

cure of 362 — 367
the ufe of purgatives in 370
the ufe of emetics in 371
the nfe of blifters in 372
the means of promoting expectoration in 373
the ufe of fweating in 374
the ufe of opiates in 375
POLYS ARCA, when a difeafe 1621
cure of 1^23 — 25
PROFLUVIA, 1045
character of the clafs ib.
PULSE, the flate of the, during the paroxyfm of an in-
termittent fever 12
PURGING, its ufe in continued fevers **44
intermit tent fevers 234
Pus, how produced 250
PUTRESCENCY of the fluids in fever, the fymptoms of 105
the tendency to in fever, how to be
corrected 222 — 226
PYLORUS, SCIRRHOUS. See Dyfpepjia.
PYREXIJE, 6
character of the clafs 7,
orders of the clafs ib.
PYROSIS, M27
fymptoms cf I431
proximate caufe of *433
remote caufes of M32
cure of 143^
Succica of Sauvages 142^

Q^

QuiNCY. See Cynanche.

RACHITIS,

INDEX.

&

RACHITIS, 1719

its origin 1720

remote caufes of 1721 — 23

phenomena of J724

proximate caufe of 1725 — 28

cure of J729 — 36

REACTION of the fyftem 59

violent in fever, fymptoms of 103

violence of, how moderated 527

REFRIGERANTS, the ufe of them in fever 134,

REMEDIES, table of thofe employed in continued fevers 227

REMISSION of fever 25

RESOLUTION of inflammation, how produced 249

RESPIRATION, the changes of, during the paroxyfm

of an intermittent 13

REVOLUTION, diurnal, in the human body 5^

RHEUMATISM, acute or chronic 4^3

Acute, the remote caufes of 405"

the proximate caufe of 44^ 460

the fymptoms of 439 — 447

cure of 461 — 470

Chronic, fymptoms of 450

how diftinguiflied from the acute 4^1

proximate caufe of 4^2

cure of 473 — 47^

how diftinguiflied from gout 526
PviCKETS. See Rachitis.
ROSE, See Erythema.
RUBEFACIENTS, the effecls of them.

S.

SCARLET FEVER, 651

the fymptoms of 636

different from cynanche maligna 651 — 6,55

the cure of 6^7 — 664

Sc ROPHULA,

the phenomena of J73^-
the proximate caufe of

not contagious 1751

not arifing from the lues venerea I7132,

the cure of 1753 — 59

Mefent erica 1606

SCUKVY,

xix INDEX.

SCURVY, 1789

remote caufe of 1792 — 1802

cure of 1 804 — 09

proximate caufe of 1811 — 14

SINAPISMS, the effects of them 197

SKIN, affections of. Sztlmpeiigijtes*

SMALL-POX, general character of 587

fymptoms of the diflindt kind 589

of the confluent kind ^90 — 593
general differences between diftinct and

confluent 594

caufes of thefe differences 595 — 600

prognolis in 593

cure of 601 — 630

inoculation off 602
the feveral practices of which it

• confifts 603
the importance of the feveral

practices belonging to 694 — 61

management of fmall-pox received by in-

feaion 616—630

SODA, 1427

SPASM, internal, means of recovering in fevers 152 — 187

the proximate caufe of inflammation L243 — 24^

SPASMODIC affection without fever 1251

of the animal functions I426

of the vital functions 1355

of the natural functions 14 27

SPACELUS, 255

SPLENITIS, 425

STIMULANTS, when to be employed in fevers 217

their ufe in intermittent fevers £30

STOMACH, its confent with the veffels on the furface of

the body 44

SuDORincSj arguments for their ufe in fevers 163 — 167

againfl their ufe in fevers 164

SUPPURATION of inflamed parts, the caufes of 251

the marks of a tendency to ib.

formed, the the marks of ib.

SURFACE of the body, its confent with the flomach 44

SWELLINGS, general. See Intumef centime.

adipofe 1621

SWELLINGS,

INDEX, xx

SWELLINGS, flatulent 1626

watery. See Dropjies.

SWEATING, wheu hurtful in continued fevers 165

rules for the conduct of in continued fevers 168

life of in intermittent fevers 230

SYNCOPE, 1171

phenomena of ib.

remote caufes of JI74 — 1178

predifpofuion to 1184

cure of 1189

diftinguifhed from apoplexy 1094

SYNOCHA. See Fever.

SYN o c HITS . See Fever.

SIPHYLIS, 1760

originally from America 1761

how propagated 1762

and gonorrhoosa, how dirlinguimed 1764

the cure of 1783—88

T.

TABES a hydrope 1609

a fanguifluxu 1608

dorfalis 1610

glan dularis 1 606

mefenterica ib.

nutricum 1608

rachialgia 1606

fcrophulofa ib-

TARTAR EMETIC, itsufe in fevers 183

TETANUS, 1257

remote caufes of 1268

cure of 1270

piflileum Barbadenfe, or Barbadoes tar, in 1280

LATERALIS, 1268

TONIC medicines employed in continued fevers 211

intermittent fevers 231

TOOTHACH, how far different from rheumatifm 4^7 — ^go

fymptoms of 47$

predifpofition to 481

remote caufes of 481 — 482

proximate caufe of 483

cure of 485—491

TRISMUS,

xxi I N D E X.

TRISMUS. See Tetanus.

NASCENTIUM, 128 f

Tussis. See Catarrh.

TYMPANITES, the charader of ^27

the different fpecies of 1628 — 30

inteftinalis 1628

enterophyfodes ib.

abdominal is ib.

afciticus ib.

phenomena of 1632

proximate caufe of 1^35 — 36

cure of 1(^37 — 44

TYPHUS. See Fever.

the fpecies of 70
V.

VAPOURS, or low fpirits. See Hypochrondriajis.

VENE RE A L D i SE A SE . See Sipbylis.

VENERY, excefs in, a remote caufe of fever 0,7

in general 1528

VlS MEDICATRIX NATURE, 38

ST. VITUS'S DANCE. See Chorea.
VOMITING OF BLOOD. See H&matemejis.

effefis of in continued fever 172 — 173

the ufe of intermitting fevers 230 — 34

U.

URINE, bloody. See H&maturia.
URTICARIA, the hiflory and treatment of 730

W.

WATEK-BRASH. See Pyrojls.
WHITES. See Leucorrhcea.

WARM-BATHING, the eile£is of in fever 198

the admiriiftration of in fever 199

the marks of the good effecls 200

WINE, the moil proper ftimulant in fevers 218

its convenient ufe in fevers 219

when hurtful or ufeful in fevers 220

THE E N D.

(>*